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What bills are covered?
The law applies to anyone with any type of health insurance except Medicare.
The law bans surprise bills:
- In emergencies.
- For air ambulance services.
- For care you receive in an in-network hospital.
- For labs and imaging ordered by an in-network doctor.
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What about ground ambulance services?
State law bans surprise bills from ground ambulance services if your insurance card has “DOI” (for department of insurance) or “TDI” (Texas Department of Insurance) printed on it. See examples.
Surprise bills are also banned if you have one of these plans:
- Employees Retirement System of Texas (ERS): HealthSelect and other ERS plans
- Teacher Retirement System of Texas (TRS): TRS ActiveCare and TRS-Care Standard for non-Medicare retirees
- Texas Farm Bureau or an employer plan that has opted into the Texas balance billing laws. The patient's insurance card might have TXI on it.
When you get out-of-network care that is protected by the law, the explanation of benefits will say that you shouldn’t get a surprise bill.
If you get a surprise bill, visit our How to get help with a surprise medical bill webpage.
You could still get a bill for your copay, coinsurance, or deductible. This bill isn’t considered a surprise bill, since you were expecting it.
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Can I still see the doctor of my choice?
The law doesn’t limit your options or change your health plan’s coverage for out-of-network care. You can still pick an out-of-network doctor if your health plan allows it.
You shouldn’t get a surprise bill if you couldn't choose your doctor (such as the radiologist who reviewed your X-ray).