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New law helps end surprise medical bills for some consumers

To The Leader

 

Starting January 1, Texans with state-regulated health insurance have new consumer protections against surprise medical bills.


Patients get surprise medical bills when they get care from a doctor, lab, or other providers outside their health plan’s network. This most often happens in two situations:


Someone has surgery or gets treatment at an in-network hospital or facility but gets care from an ER doctor, anesthesiologist, radiologist, or other providers who don’t have a contract with their health plan.


Someone gets treatment for an emergency at an out-of-network hospital or emergency facility.


The new law bans doctors and providers from sending balance bills to patients in those cases. Instead, health care providers can apply for arbitration or mediation to resolve payment issues with insurers cover those bills. The new law keeps consumers out of the middle of those disputes.


Here’s what you should know about the new law.

Who qualifies?

The new law applies to state-regulated insurance plans and people with coverage through the state employee or teacher retirement systems – or about 16% of Texans. Insurance cards for state-regulated plans have either “DOI” (for the department of insurance) or “TDI” (Texas Department of Insurance) printed on them. (See examples.) It does not apply to many employer-sponsored plans or Medicare.

When do the new protections start?
The new law applies to medical services received on or after January 1. For a bill for services before January 1, visit the TDI website to learn about your options.

Can I still see the doctor of my choice?
The new 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 new law applies in emergencies and situations where you didn’t select the doctor (such as the radiologist who reviewed your X-ray).