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Texas Department of Insurance
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How to get help with a surprise bill from a health care provider

Mediation for a health insurance claim

Read these instructions if you got medical services, supplies, or emergency care on or after January 1, 2018.

We can help you with your surprise bill if:

  • You have health coverage through one of the following:
    • An insured preferred provider benefit organization (PPO).
    • The Employees Retirement System of Texas.
    • the Teacher Retirement System of Texas.
  • The amount of the bill is more than $500, not including copays, deductibles, and coinsurance.
  • You didn’t sign an estimate that shows a cost of services that is the same or less than your bill.
  • You were billed for:
    • Emergency care by a doctor, hospital, clinic, or other health care provider that isn’t in your health plan’s network.
    • Medical services or supplies:
      • By a facility-based doctor or other health care provider who isn’t part of your health plan’s network.
      • At one of the following places in your health plan’s network:
        • Hospital.
        • Ambulatory surgical center.
        • Birthing center.
        • Freestanding emergency medical care facility.

If you meet the above rules:

  1. Get these three documents together:
    • A copy of the front of your health insurance ID card.
    • A copy of your Explanation of Benefits (EOB) form. Your insurance company sends this form to you after you get health care services.
    • A copy of the doctor or provider’s bill.
  2. Fill out the form and attach the documents listed in step A:

Learn more about how this process works:

Visit our How Mediation Works web page.

If you aren’t able to get help with a surprise bill:

You can file a complaint about your health insurance. To learn more, go to our Insurance Complaint Process web page.

Questions? Call us at 800-252-3439.

Last updated: 11/18/2022