Texas Medical Bill Rights & Programs: What to Do When You're Overbilled
Know your rights under Texas law for medical billing, surprise bills, collections limits, financial assistance requirements, and how to dispute unfair charges.
Texas Patient Protections at a Glance
No Surprise Emergency Bills
Protected from balance billing
Itemized Bill Rights
Must be provided on request
365-Day Credit Protection
Before medical debt reports
Charity Care Required
At nonprofit hospitals
No Surprises Act (when it applies in TX)
You're Protected From Balance Billing For:
- Emergency Services: Emergency care at a hospital emergency department or an independent freestanding emergency department (including out‑of‑network)
- Non-Emergency at In-Network Facilities: Out‑of‑network clinicians (anesthesia, radiology, pathology, etc.) at in‑network hospitals/facilities (no balance billing in most cases)
- Air Ambulance: Emergency medical transport (ground ambulance not covered federally, check local protections)
What You Should Pay:
Only your in-network cost-sharing (copay, coinsurance, deductible). The provider and insurer must work out the rest—you're not responsible for the difference.
If You Receive a Surprise Bill:
- 1. Don't pay it immediately
- 2. Call your insurance to confirm it's being processed correctly
- 3. File a complaint at cms.gov/nosurprises or call 1-800-985-3059
- 4. Request "good faith estimate" dispute if uninsured and bill exceeds estimate by $400+
Financial Assistance & Hospital Requirements
Texas Hospital Requirements:
- Nonprofit Hospitals Must: Offer financial assistance, post policies publicly, screen for eligibility, provide emergency care regardless of ability to pay
- Financial Assistance Caps (Nonprofit): FAP‑eligible patients cannot be charged more than Amounts Generally Billed (AGB); many hospitals also offer self‑pay discounts and payment plans—ask and get it in writing
- Transparency: Itemized bills must be provided; Texas hospitals and freestanding ERs must give an itemized bill before collecting payment, and hospitals must publish machine‑readable price lists online
Common Eligibility Thresholds:
• 100% Free Care: Usually ≤200% Federal Poverty Level (FPL)
• Sliding Scale Discounts: 201-400% FPL
• Catastrophic Help: Many hospitals offer assistance when medical bills exceed a share of annual income (policy‑specific)
• Payment Plans: Often interest-free for 12-24 months
Collections & Credit Reporting Timelines
| Timeline | What Happens | Your Rights |
|---|---|---|
| Day 0-30 | First bill sent | Request itemized bill, verify insurance processing |
| Day 31-120 | Follow-up bills, payment plan offers | Apply for financial assistance, negotiate |
| Day 121-180 | Final notice before collections | Request supervisor review, payment arrangement |
| Day 181-364 | May go to collections | Cannot appear on credit report yet |
| Day 365+ | Can report to credit bureaus | Only if $500+; removed when paid |
Important: Texas prohibits wage garnishment for consumer debt (including medical). Your primary residence and retirement accounts are also protected from medical debt collectors.
Payment Plans & Hardship Policies
Your Payment Options in Texas:
Interest-Free Payment Plans
- • Most hospitals offer 6-24 month plans with no interest
- • Can often set up with as little as $25-50/month
- • Prevents collections while you're making payments
Prompt Pay Discounts
- • 10-40% off for paying within 30 days
- • Ask: "What's your prompt pay or cash discount?"
- • Get the discount agreement in writing
Hardship Programs
- • Job loss, disability, or family emergency qualifications
- • May reduce or eliminate balance entirely
- • Catastrophic caps when bills exceed 10% of income
How to Dispute a Bill (Step-by-Step)
Request Itemized Bill
Call billing. Say: "I need a fully itemized bill with line items, codes, and descriptions." Texas hospitals and freestanding ERs must provide an itemized bill.
1 phone call
Review for Errors
Common issues: Duplicate charges, upcoding (billing for more complex service), unbundling (charging separately for included items), services not received.
30 minutes
Gather Documentation
Collect: Medical records, insurance EOB, previous bills, notes from appointments, discharge papers.
1 hour
Call to Dispute
Ask for supervisor. State specific errors. Request billing hold during review. Get reference number.
30-60 minutes
Send Written Dispute
Send certified mail with: Cover letter explaining errors, copies of supporting documents, request for corrected bill.
1 hour
Escalate if Needed
If unresolved after 30 days: File complaint with Texas Department of Insurance, contact hospital patient advocate, consider legal aid.
Varies
Sample Dispute Letter Template:
State Agencies & Help Lines
Texas Resources for Medical Bill Help:
Texas Department of Insurance
For: Insurance claim denials, surprise bills, network issues
File complaint online →Texas Attorney General
For: Billing fraud, unfair practices, debt collection violations
File consumer complaint →Federal No Surprises Help Desk
For: Surprise bills, balance billing, good faith estimate disputes
File complaint online →Texas Health and Human Services
For: Medicaid issues, CHIP, hospital compliance
Visit HHSC website →Pro Tip: When calling, write down: Date, time, representative name, reference number, and what was promised. This documentation is crucial if you need to escalate.
Frequently Asked Questions
What is the No Surprises Act in Texas?
How long do I have to dispute a medical bill in Texas?
Are Texas hospitals required to offer financial assistance?
Can medical debt affect my credit in Texas?
What are prompt pay discounts in Texas?
How do I file a complaint about medical billing in Texas?
Take Action Now
Major Texas Hospital Financial Assistance Programs:
Related Resources:
Disclaimer: This information is for educational purposes only and is not legal advice. Laws and regulations may change. Always verify current requirements with official sources or consult with a qualified attorney for specific legal guidance. CareRoute does not provide legal services.