Texas Medical Bill Rights

42 U.S.C. § 300gg-111 (No Surprises Act)

Federal law (effective January 1, 2022) prohibits surprise out-of-network bills for emergency services, air ambulance services, and most non-emergency services at in-network facilities. Patients owe no more than the in-network cost-share. Providers and insurers must resolve payment disputes through Independent Dispute Resolution, not by billing the patient.

Tex. Ins. Code § 1467.001 et seq. (SB 1264)

Texas prohibits balance billing for emergency services and for facility-based services delivered at in-network hospitals by out-of-network providers. Patients owe only the in-network cost-share; remaining disputes go to state mediation or arbitration.

26 U.S.C. § 501(r) (Nonprofit Hospital Financial Assistance Requirement)

Federal law requires every nonprofit (501(c)(3)) hospital to maintain a written Financial Assistance Policy, publicize it widely, and screen all uninsured/underinsured patients for eligibility before sending unpaid bills to collections. Patients eligible for assistance cannot be charged more than the Amounts Generally Billed (AGB) to insured patients. Applies to roughly 3,000 nonprofit hospitals (about 58% of all US hospitals, 80% of beds).

15 U.S.C. § 1692 et seq. (Fair Debt Collection Practices Act)

Federal law restricts how third-party debt collectors may contact consumers about medical or other debts. Consumers may demand written validation of any debt within 30 days of first contact; collectors must cease communication if requested in writing; harassment, deception, and unfair practices are prohibited.

Tex. Ins. Code § 1351.354 (Independent Review)

Texas patients have 180 days from a final adverse determination to request Independent Review through the Department of Insurance. IRO decisions are binding on the insurer.

Tex. Health & Safety Code § 311.0025

Texas hospitals must provide an itemized statement of charges upon written request within 10 business days. Patients may dispute any charge in writing within 30 days of receiving the itemized statement.