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What bills are covered?
The law applies to anyone with any type of health insurance except Medicare.
The law bans surprise bills:
- In emergencies.
- For air ambulance services.
- For care you receive in an in-network hospital.
- For labs and imaging ordered by an in-network doctor.
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What about ground ambulance services?
State law bans surprise bills from ground ambulance services if you have a state-regulated plan.
You have a state-regulated plan if:
- Your insurance card has “DOI” (for department of insurance) or “TDI” (Texas Department of Insurance) printed on them. See examples
- You have insurance with:
- Employees Retirement System of Texas (ERS): HealthSelect and other ERS plans
- Teacher Retirement System of Texas (TRS): TRS ActiveCare and TRS-Care Standard for non-Medicare retirees
- Texas Farm Bureau or an employer plan that has opted into the Texas balance billing laws. The patient's insurance card might have TXI on it.
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When you get out-of-network care that is protected by the law, the explanation of benefits will say that you shouldn’t get a surprise bill.
If you get a surprise bill, visit our How to get help with a surprise medical bill webpage.
You could still get a bill for your copay, coinsurance, or deductible. This bill isn’t considered a surprise bill, since you were expecting it.
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Can I still see the doctor of my choice?
The law doesn’t limit your options or change your health plan’s coverage for out-of-network care. You can still pick an out-of-network doctor if your health plan allows it.
You shouldn’t get a surprise bill if you couldn't choose your doctor (such as the radiologist who reviewed your X-ray).