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

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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. Who can get help?

    If you get a surprise bill for services between January 1, 2020, and December 31, 2021:

    The law applies only to state-regulated insurance plans. You have a state-regulated plan if:


    If you get a surprise bill for services on or after January 1, 2022:

    The law applies to anyone with any type of health insurance except Medicare.

  2. What bills are covered?

    If you get a surprise bill for services between January 1, 2020, and December 31, 2021:

    The law bans balance bills: (1) in emergencies, or (2) when the patient didn’t have a choice of doctors for medical services.


    If you get a surprise bill for services on or after January 1, 2022:

    The law bans balance bills: (1) in emergencies, (2) when the patient didn’t have a choice of doctors for medical services, or (3) for air ambulance services.

    If you get a balance bill, visit our How to get help with a surprise medical bill webpage.

  3. 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. If your health plan allows you to pick an out-of-network doctor, you can still do so. The law applies:

    • In emergencies.
    • When you didn’t pick the doctor (such as the radiologist who reviewed your X-ray).
    • When you get air ambulance services.

 

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For more information, contact: MediaRelations@tdi.texas.gov

Last updated: 8/24/2022