Medical Billing Rights
Written in plain language for general understanding. This is educational content, not legal advice. Based on federal statutes and official sources.
What is this right?
The No Surprises Act, which took effect on January 1, 2022, protects you from unexpected medical bills when you receive emergency care or are treated by an out-of-network provider at an in-network facility. Before this law, patients could receive bills for thousands of dollars from doctors or hospitals they did not choose.
Under the No Surprises Act, out-of-network providers cannot bill you more than your in-network cost-sharing amount in most emergency and certain non-emergency situations. If you are uninsured or choose to self-pay, you have the right to a good faith estimate of costs before treatment. You also have the right to an itemized bill for any medical services, and you can dispute charges you believe are incorrect.
When does it apply?
This right applies when:
- You receive emergency care at any hospital or emergency room, regardless of network status
- An out-of-network doctor (such as an anesthesiologist, radiologist, or pathologist) treats you at an in-network hospital
- You are airlifted or transported by an out-of-network air ambulance
- You are uninsured or choose to self-pay and want to know costs up front
- You receive a bill you believe is incorrect or too high
Common misconceptions:
- “The No Surprises Act covers all medical bills” — It primarily covers emergency services and out-of-network providers at in-network facilities. If you knowingly choose an out-of-network provider and sign a consent notice, you may still receive higher bills.
- “I can't fight a medical bill” — You can always request an itemized bill, dispute charges, and ask for a payment plan or financial assistance.
- “If I'm uninsured, I have no billing protections” — The No Surprises Act requires providers to give uninsured patients a good faith estimate. If the final bill exceeds the estimate by $400 or more, you can dispute it through the patient-provider dispute resolution process.
What should you do?
Step 1: If you are uninsured or self-paying, ask for a good faith estimate before any scheduled service. Providers and facilities must give you an estimate of expected charges. Keep this document.
Step 2: Review every medical bill you receive. Request an itemized bill that lists each service, supply, and charge individually. Compare it with the explanation of benefits (EOB) from your insurer.
Step 3: If you receive a surprise bill for emergency care or from an out-of-network provider at an in-network facility, contact your insurer and the provider. Under the No Surprises Act, you should only owe your in-network cost-sharing amount (copay, coinsurance, or deductible).
Step 4: If the final bill exceeds your good faith estimate by $400 or more, start the patient-provider dispute resolution process at cms.gov/nosurprises or call 1-800-985-3059. You must initiate the dispute within 120 days of the bill.
Step 5: Ask about financial assistance. Nonprofit hospitals are required to have charity care programs under IRS rules (26 U.S.C. § 501(r)). Many for-profit hospitals also offer financial assistance or payment plans. Always ask for a financial counselor.
What should you NOT do?
Don't ignore medical bills. Unpaid medical bills can be sent to collections and damage your credit score. Even if you plan to dispute a bill, respond within the timeframes given.
Don't sign a waiver of your surprise billing protections unless you understand the consequences. Some out-of-network providers may ask you to sign a “notice and consent” form giving up your No Surprises Act protections. You are never required to sign this for emergency services, and for non-emergency services, you should understand that signing means you agree to pay out-of-network rates.
Don't pay a bill you believe is wrong without questioning it. Medical billing errors are common. Studies estimate that a significant percentage of medical bills contain mistakes. Always request an itemized bill and check it carefully.
Don't assume you cannot negotiate. Many providers will reduce bills, set up interest-free payment plans, or offer discounts for prompt payment. Ask before paying the full amount.
How Texas differs from federal law
Texas has state-level billing protections that work alongside the federal No Surprises Act:
- SB 1264 (Insurance Code § 1467, effective 2019): Texas' surprise billing law protects patients from balance billing by out-of-network providers in emergency situations and at in-network facilities. Applies to state-regulated insurance plans (not self-insured employer plans, which are covered by the federal No Surprises Act).
- Texas Medicaid: Texas has one of the most restrictive Medicaid programs in the country — it has not expanded Medicaid under the ACA. Eligibility for adults is limited, generally covering only very low-income parents (about 15% FPL), pregnant women, and people with disabilities.
- Charity care: Texas nonprofit hospitals must have financial assistance policies, but Texas does not have a statewide charity care mandate as strong as some other states. Each hospital sets its own eligibility thresholds.
- Balance billing protections: Under Texas Insurance Code § 1467, if you go to an in-network facility, you are protected from out-of-network balance bills from facility-based providers like anesthesiologists and radiologists. The provider and insurer must resolve payment disputes through mediation or arbitration.
Additional Steps in Texas
File a surprise billing complaint with the Texas Department of Insurance at tdi.texas.gov or call (800) 252-3439. For Medicaid issues, contact Texas Health and Human Services Commission at hhs.texas.gov or call (800) 335-8957. Contact the Texas Legal Services Center Health Law Helpline for free billing assistance.
Relevant Law: Texas Insurance Code § 1467 (SB 1264 — surprise billing), Texas Insurance Code Chapter 1467 (mediation and arbitration), Texas Human Resources Code § 32.001 et seq. (Medicaid)
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