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Texas Department of Insurance
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Balance billing: state-regulated health plan resources

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Use the Independent Dispute Resolution portal to submit mediation and arbitration requests and check on claims.

Responsibilities of health plans regulated by TDI

  • State law requires health plans to cover medical screenings necessary to rule out that an emergency condition exists.
  • Claim denials based on a failure to meet the prudent layperson standard for emergency care must be based on a review of the patient’s presenting symptoms, not on the later diagnosis code.
  • Plans must meet statutory deadlines to promptly adjudicate clean claims.
  • Plans must be ready to provide accurate information about the surprise billing laws. This includes required notices about mediation and arbitration on explanations of benefits (EOBs) and the ability to quickly respond to questions from policyholders and providers.



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Last updated: 1/5/2022