Surprise Medical Bills

A surprise medical bill, also known as balance billing, happens when you get an unexpected bill from a doctor, hospital, or other health care provider who isn’t part of your health plan’s network (out-of-network provider or at an out-of-network facility). 

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. 

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.  

Yes. For more information on how Texas laws and the Federal NSA differ visit the Texas Medical Association.

Note: The No Surprises Act supplements state surprise billing laws; it does not replace them. 

First, you should contact your health plan. Ask them why you received the bill and if it is correct. File an appeal with your health plan if you are denied and call the doctor/ provider who billed you for more information. 

For more information on what to do if you receive a surprise medical bill, read  "How to get help with a surprise medical bill" on the Texas Department of Insurance website.