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Texas Department of Insurance
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How consumers are protected from surprise medical bills


Patients get surprise medical bills if they get care outside their health plan’s network without realizing it. For example, you will probably pick a surgeon in your plan’s network. But you may not be asked about the anesthesiologist (a doctor who "puts you to sleep").

State and federal laws protect patients from surprise medical bills.

  1. 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.
  2. 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:

  3. 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.

  4. 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).


Questions? Call us at 800-252-3439.

Last updated: 4/23/2024