Stay connected!Use the Independent Dispute Resolution portal to submit mediation and arbitration requests and check on claims.
Plans not regulated by TDI
Starting January 1, 2022, the federal No Surprises Act will protect Texas consumers with health plans not regulated by the state from surprise bills for:
- Air ambulance services.
- Emergency care.
- Care provided at in-network facilities when the patient didn’t have a choice of doctors.
To learn more about federal laws and rules, see the Centers for Medicare & Medicaid Services’ webpages: Overview of rules & fact sheets and Provider requirements and resources.
Plans regulated by TDI
Texas and federal laws protect Texas consumers with state-regulated health plans from surprise bills.
- Federal law bans balance bills for air ambulance services received on or after January 1, 2022.
- State law bans balance bills for the following received on or after January 1, 2020:
- Emergency care.
- Care provided at in-network facilities when the patient didn’t have a choice of doctors.
State law authorizes arbitration (for doctors) and mediation (for facilities) to resolve payment disputes in those cases.
The law carves out a narrow exception when a consumer chooses an out-of-network doctor or provider at an in-network facility. See Balance billing waiver information below.
How can you tell if a plan is regulated by TDI?
- The patient’s insurance card will have TDI or DOI on it. See examples
- The patient is insured through the Employees Retirement System of Texas (ERS): HealthSelect and other ERS plans
- The patient is insured through the Teacher Retirement System of Texas (TRS): TRS ActiveCare and TRS-Care Standard for non-Medicare retirees
Resources and webinars
- Centers for Medicare & Medicaid Services’ Provider requirements and resources
- FAQ: What doctors should know about the Texas balance billing law
- Texas mediation and arbitration rules (PDF)
- List of TDI certified mediators and arbitrators
- Recorded webinar: Benchmarking database for providers
- Recorded webinar: Mediation / arbitration portal demo for providers | PowerPoint slides