Stay connected!ERISA plan sponsors can opt in to IDR. Complete this form.
Use the Independent Dispute Resolution portal to submit mediation and arbitration requests and check on claims.
Texas and federal laws prohibit out-of-network providers, facilities, and ambulances from balance billing for certain health care services.
Consumers with issues about a health care bill can use our page to learn how to get help with a surprise medical bill.
Texas and federal laws
Texas law applies to health plans regulated by TDI
Texas laws ban balance billing for:
- Certain medical services or supplies provided on or after January 1, 2020.
- Emergency medical services (EMS) and trips provided by a ground ambulance on or after January 1, 2024.
It doesn’t apply to air ambulance services.
Health plans have to pay an amount set by Texas law for EMS care and ground ambulance trips. You don’t have to pay more than your deductible, copay, or coinsurance.
Health plans and out-of-network providers and facilities must use the Independent Dispute Resolution (IDR) portal to mediate or arbitrate disputes without involving the consumer:
- Mediation: Used for billing disputes between out-of-network facilities and health plans.
- Arbitration: Used for billing disputes between out-of-network health care providers (not facilities) and health plans.
Federal law applies to health plans not regulated by TDI and air ambulance services.
As of January 1, 2022, federal law prohibits health care providers and facilities and air ambulance service providers from balance billing for certain items and services. It also requires Texas to enforce state laws against balance billing and manage its IDR system for state-regulated health plans.
Learn more about the federal No Surprises Act on the Centers for Medicare & Medicaid Services’ webpage: Overview of rules & fact sheets
Texas laws and rules
Texas statute and rules outline the resolution process for certain billing disputes for state-regulated health plans and ERISA plans that have opted in:
- Texas Senate Bill 1264
- Texas Insurance Code Chapter 1467
- Texas Insurance Code Chapter 1456
- Adoption Order 2019-6172 for the Out-of-Network dispute Resolution rules
- 28 Texas Administrative Code Subchapter PP
- Texas House Bill 3924
- Texas House Bill 1592 allows ERISA plans to elect participation in IDR
- Adoption Order 2023-8410 for election by ERISA plans
Balance billing information
- Consumers: How to get help with a surprise medical bill
- Health care providers
- State-regulated health plans
- Self-insured health plans (CMS.gov)
- Texas mediators and arbitrators