Your Rights and Protections Against Surprise Medical Bills
When you get emergency care or are treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from balance billing. In these cases, you shouldn’t be charged more than your plan’s copayments, coinsurance and/or deductible.
When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, like a copayment, coinsurance, or deductible. If you see a provider or visit a health care facility that isn’t in your health plan’s network, you may have additional costs or have to pay the entire bill.
“Out-of-network” means providers and facilities that haven’t signed a contract with your health plan to provide services. Out-of-network providers may be allowed to bill you for the difference between what your plan pays and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your plan’s deductible or annual out-of-pocket limit.
“Surprise billing” can happen when you can’t control who is involved in your care—like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider. Surprise medical bills could cost thousands of dollars depending on the procedure or service.
Need an Estimate?
You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost. For more information please email your request to our Customer Service Office at UTPCustomerService@uth.tmc.edu, or learn more here.
Need Assistance?
If you think you’ve been wrongly billed:
You may contact our UTHealth Houston and UT Physicians Customer Service Office at 1-855-877-2808, or send an email to our team at UTPCustomerService@uth.tmc.edu.
If you have a State of Texas regulated insurance plan or have coverage through the Texas employee or Teacher Retirement System, then you may have additional protections regarding surprise medical bills. For more information, please visit https://www.tdi.texas.gov/medical-billing/index.html.
For information or assistance with balance billing questions from the State of Texas Department of Insurance, visit https://www.tdi.texas.gov/medical-billing/surprise-balance-billing.html.
Visit http://www.cms.gov/nosurprises for more information about your rights under federal law. The federal phone number for information and complaints is: 1-800-985-3059.
