Balance billing: Independent Dispute Resolution
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Federal and Texas laws
Federal law applies to health plans not regulated by TDI and air ambulance services.
Starting January 1, 2022, federal law prohibits health care providers and facilities and air ambulance service providers from balance billing for certain items and services. It also requires Texas to continue enforcing state laws against balance billing and managing its independent resolution dispute system for state-regulated health plans.
Learn more about the federal No Surprises Act on the Centers for Medicare & Medicaid Services’ webpage: Overview of rules & fact sheets
Texas law applies to health plans regulated by TDI, but not ambulance services.
The Texas law, passed in 2019, bans balance billing for certain medical services or supplies received on or after January 1, 2020. It does not apply to air or ground ambulance services.
Health plans and out-of-network providers and facilities must use the Independent Dispute Resolution portal to mediate or arbitrate disputes:
- Mediation: Used for billing disputes between out-of-network facilities and health plans.
- Arbitration: Used for billing disputes between out-of-network health care providers (not facilities) and health plans.
Texas statute and rules outline the resolution process for certain billing disputes for state-regulated health plans:
