Does Texas have a no surprise billing law?
Asked by: Shea Nader | Last update: September 19, 2025Score: 4.3/5 (25 votes)
What is the law on medical billing in Texas?
A new Texas law requires health care providers to send an itemized bill before the account can be sent to collections. The itemized bill must contain "plain language descriptions" of the services provided.
Is balance billing prohibited in Texas?
Texas law also prohibits balance billing for any health care, medical service or supply provided at an in-network facility by an out-of-network physician or other provider and for services by diagnostic imaging providers and laboratory service providers provided in connection with a health care service performed by a ...
How do I dispute a surprise medical bill in Texas?
If you think you've been wrongly billed, contact the Centers for Medicare and Medicaid Services at 1-800-985-3059 or the Texas Department of Insurance at 1-800-252-3439. Visit https://www.cms.gov/nosurprises/consumers for more information about your rights under federal law.
What are the exceptions to the No Surprise Act?
The No Surprises Act Protections Do Not Apply:
Medicare (including Medicare Advantage). Medicaid (including Medicaid managed care plans). Indian Health Service. Veterans Affairs Health Care.
Loophole could affect Texas surprise medical bill law | KVUE
What is the law on unpaid medical bills in Texas?
Under Texas laws, the statute of limitations on medical bills debts is 4 years. This means that if your healthcare provider does not initiate a lawsuit within 4 years, they cannot sue you to recover your unpaid balances.
What is required in a no surprise billing act notice?
The NSA Notice must include: (1) a plain-language summary of the consumer protections afforded by the NSA; (2) a plain-language summary of any applicable state balance billing law; and (3) appropriate contact information for state and federal agencies that an individual may contact if the individual believes the ...
What is the no surprise billing in Texas?
As of January 1, 2022, the No Surprises Act (NSA) protects you from surprise billing if you have a group health plan or group or individual health insurance coverage. The NSA is a federal law that prohibits balance billing for out-of-network, self-pay, and uninsured patients from certain surprise medical bills.
How do I complain about medical billing in Texas?
To place a complaint:
Submit your complaint electronically via the Online Complaint Form, or print a PDF version COMPLAINT FORM (SPANISH COMPLAINT FORM ) and mail it in, or call the Complaint Hotline 1-800-201-9353 and follow the automated prompts to request a complaint form.
What are unethical billing practices?
These may include sudden and significant bill increases without transparent explanations, discrepancies between agreed-upon rates and invoiced amounts, and vague or inconsistent billing practices.
Can a doctor bill you two years later in Texas?
Section 146.002 - Timely Billing Required (a) Except as provided by Subsection (b) or (c), a health care service provider shall bill a patient or other responsible person for services provided to the patient not later than the first day of the 11th month after the date the services are provided.
What is the difference between balance billing and surprise billing?
In many cases, the out-of-network provider could bill consumers for the difference between the charges the provider billed, and the amount paid by the consumer's health plan. This is known as balance billing. An unexpected balance bill is called a surprise bill.
What is the No Surprise Billing Act 2024?
December 12, 2024 – The No Surprises Act, a law that ended the practice of “balance billing” by certain out-of-network providers, was enacted as part of the Consolidated Appropriations Act of 2021 on December 27, 2020.
What is the golden rule in medical billing?
The golden rule of healthcare billing and coding departments is, “Do not code it or bill for it if it's not documented in the medical record.” Providers use clinical documentation to justify reimbursements to payers when a conflict with a claim arises.
Can I sue for improper medical billing?
While billing errors are generally not the basis for a lawsuit, there are many steps consumers can take themselves in this situation.
What is the statute of limitations on billing in Texas?
The statute of limitations on debt in Texas is four years. This section of the law, introduced in 2019, states that a payment on the debt (or any other activity) does not restart the clock on the statute of limitations for debt buyers.
What is an example of surprise billing?
A consumer goes to an in-network lab or imaging center for tests and the doctor who reads the results is not in their health insurer's network. That doctor then bills the consumer for their services creating a surprise bill.
Can a hospital sue you for unpaid medical bills in Texas?
Legal Action: Persistent non-payment can lead to legal action. Healthcare providers or collections agencies may sue you to recover the debt, potentially resulting in wage garnishment or liens on your property.
Can a doctor bill you four years later?
In most states, the statute of limitations to collect on unpaid medical bills is between three and six years. However, in some states, a creditor has between 10-15 years to try and collect on the debt. In the table below, we've outlined the statute of limitations on medical debt in every state.
How can I get help with medical bills in Texas?
texashealth.org/Costs-and-Billing/Financial-Assistance
Our Customer Service Department can assist you with scheduling an appointment or help with any questions about the Financial Assistance Policy or application process by calling 800.890. 6034.
What does no bill mean in Texas?
The first option at a grand jury is when the case is “no billed.” This means that the grand jury did not find probable cause for the arrest. This means that the case will not proceed to trial unless another grand jury finds probable cause with additional evidence.
Why is surprise billing bad?
Abstract. Surprise medical bills received after care delivery in both emergency and non-emergency situations for out-of-network (OON) or other contractual health plan regulations adds additional stress upon the care guarantor, most often the patient.
How is the No Surprises Act enforced?
Enforcement of state laws is handled by the respective state agencies, such as a state's department of insurance. States have primary enforcement authority over health insurance issuers, facilities, and providers (including air ambulance services providers) with respect to the No Surprises Act.
How to get out of paying medical bills?
Ask if the provider will accept an interest-free repayment plan. Look for help paying medical bills, prescription drugs, and other expenses. Some nonprofit organizations provide financial help as well as help for drugs necessary for your medical care or even certain medical conditions.
Why am I being charged more than my copay?
Non-Covered Services: Some medical services or prescription medications may not be covered by your insurance plan. If this is the case, you will be responsible for the full cost of the service or medication, which may exceed your copayment.