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Protecting Your Money: 'Surprise' or balance medical billing

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Posted at 4:32 PM, Apr 20, 2022

CORPUS CHRISTI, Texas — "Consumers can, in the past, before the state law was passed, could receive a bill for medical services that they received, that's over and above of what they were expecting to pay."

That's Cindy Wright with the Texas Department of Insurance's Consumer Protection Division, talking about Senate Bill 1264.

The bill passed in 2020, and is designed to remove patients from billing disputes between state-regulated health insurance plans and health care providers. In other words, to protect consumers who receive "surprise" or balance medical billing.

"So the law prohibits the provider from balance billing the consumer, and then that dispute that remains, is absolutely between the provider and the health plan. And the consumer's protected from that," Wright adds.

But, does this new state law apply to all Texans? Not necessarily.

How can you check to see if it applies to you?

"Pull out your health insurance card. You might see a code in front. Either DOI, Department of Insurance, or TDI, Texas Department of Insurance. If you see that code, it's a sure bet," Wright said.

TDI estimates Bill 1264 applies to roughly 15-20 percent of Texans with private health insurance.

In the first 18 months of implementation, TDI reports they received nearly 100,000 eligible requests to resolve medical billing totaling $450 million.

Remember, you're still responsible for meeting your co-pay and deductible, but there's no deadline to file your dispute of the surprise charges.

So how do you protect yourself from "surprise" or balance medical billing?

Wright recommends always plan ahead.

Check with your provider about what's covered, find your nearest emergency facilities and call TDI's Consumer Help line at 1-800-252-3439. You can also go to their website.