Fighting Medical Debt in Texas
I got a medical bill I can't afford — here's what Texas law says and what to do next.
Statute: Tex. Ins. Code § 1271.157; Tex. Health & Safety Code § 324.101 et seq. (Texas Out-of-Network Billing Protections — SB 1264)
Deadline: 120 days
Penalty: Texas has comprehensive surprise billing protections under SB 1264 with mediation and arbitration processes. Texas was one of the first states to enact strong balance billing protections. Violations may result in penalties from the Texas Department of Insurance
What is fighting medical debt?
Medical debt is the leading cause of bankruptcy in the United States, affecting an estimated 100 million Americans. Recent federal actions have significantly strengthened your rights when dealing with medical debt — including new rules removing most medical debt from credit reports and protections against surprise billing.
The No Surprises Act (effective January 2022) protects you from unexpected bills when you receive emergency care or are treated by an out-of-network provider at an in-network facility without your consent. Additionally, the three major credit bureaus voluntarily removed medical debt under $500 from credit reports in 2023, and the CFPB finalized a rule in January 2025 to remove all medical debt from credit reports, but a federal court vacated that rule in July 2025 (Cornerstone Credit Union League v. CFPB) before it took effect.
What to Do If You Get a Medical Bill You Can't Afford
Step 1: Request an itemized bill. Medical billing errors are extremely common — studies suggest up to 80% of medical bills contain errors. Compare the itemized bill against your insurance Explanation of Benefits (EOB).
Step 2: If you received a surprise bill (out-of-network charges you didn't consent to), file a complaint under the No Surprises Act. Contact your insurer, the provider, and CMS at 1-800-985-3059. You should only owe your in-network cost-sharing amount.
Step 3: Ask the hospital about financial assistance. If the hospital is a nonprofit (most are), they must have a financial assistance policy. Request the application — you may qualify for free or reduced-cost care even with insurance.
Step 4: Negotiate the bill. Hospitals regularly accept less than the full amount. Ask for a reduction, a payment plan with no interest, or offer a lump-sum settlement for a lower amount. Get any agreement in writing.
Step 5: If the debt goes to collections, know your FDCPA rights. Request debt validation in writing within 30 days. Medical debt collectors must follow the same rules as any other debt collector. If the debt is on your credit report, check whether it qualifies for removal under the new credit reporting rules.
How Texas differs from federal law
Texas provides significant debtor protections that benefit those with medical debt:
- No wage garnishment (Tex. Const. Art. XVI, § 28): Texas constitutionally prohibits wage garnishment for consumer debts, including medical debt. This is the single most important protection for Texans with medical debt — creditors cannot take money directly from your paycheck. Exceptions exist only for child support, student loans, taxes, and court-ordered restitution.
- Balance billing protections (SB 1264, 2019): Texas was a national leader in surprise billing protections. SB 1264 prohibits out-of-network providers from balance billing patients for emergency care and at in-network facilities. This preceded the federal No Surprises Act and applies to state-regulated plans.
- Statute of limitations: The statute of limitations for medical debt in Texas is 4 years (Tex. Civ. Prac. & Rem. Code § 16.004). After 4 years, creditors cannot sue to collect the debt.
- Hospital financial assistance: Texas requires licensed hospitals to develop and implement financial assistance policies for uninsured and underinsured patients (25 Tex. Admin. Code § 13.401). Each hospital sets its own eligibility thresholds, but patients should always ask about charity care programs.
- Homestead protection: Even if a medical creditor obtains a judgment, the Texas homestead exemption (Tex. Prop. Code § 41.001) protects your primary residence from seizure for medical debt.
Additional steps in Texas
Request an itemized bill and dispute any errors in writing. Ask the hospital about financial assistance or charity care programs. File complaints with the Texas Department of Insurance at tdi.texas.gov or call (800) 252-3439. For free legal help with medical debt, contact Texas RioGrande Legal Aid at trla.org or the Texas Legal Services Center Health Law Helpline.
What you should NOT do
Don't pay a bill you haven't verified. Always request an itemized bill and compare it to your insurance EOB before paying. Errors are extremely common.
Don't put medical debt on a credit card. Medical debt has special protections (lower interest, financial assistance eligibility, credit reporting limits) that you lose once you transfer it to a credit card.
Don't ignore the bill entirely. While medical debt protections are expanding, ignoring bills can lead to lawsuits, wage garnishment, and damage to your credit that could have been avoided through negotiation or financial assistance.
Don't assume you don't qualify for financial assistance. Income thresholds for hospital charity care programs are often surprisingly high (200-400% of the federal poverty level). Apply even if you think your income is too high.
You shouldn't have to hire a lawyer to assert your rights.
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Generate your medical bill dispute →This page is general legal information for Texas, not legal advice for your specific situation. Laws change, and how a statute applies depends on facts we don't know. For advice on your matter, consult a licensed attorney in Texas.