Surprise Billing Facts
At United Regional, protecting you from unexpected medical costs matters. Learn how federal and Texas laws safeguard you from surprise billing when you receive emergency or out-of-network care at in-network facilities.
Your Rights and Protections Against Surprise Medical Bills
If you get emergency care or are treated by an out-of-network provider at an in-network hospital or surgical center, you’re protected from surprise medical bills — also called balance billing.
What is balance billing?
Balance billing happens when you're charged the difference between what your health plan pays and what an out-of-network provider charges. These providers haven’t signed contracts with your health plan and may bill you more than in-network providers for the same service. This can lead to higher costs that don’t count toward your annual out-of-pocket limit.
Surprise billing is a type of balance billing that occurs when you can’t choose who treats you — like during emergencies or when an out-of-network provider treats you at an in-network facility.
When You’re Protected
You’re protected from balance billing in these situations:
- Emergency services: If you have an emergency and get care from an out-of-network provider or facility, you’ll only pay your plan’s in-network cost-sharing (like copays or coinsurance). You can’t be balance billed — even after you’re stable — unless you give written consent.
- Texas law: If you have state-regulated insurance (about 16 percent of Texans), you’re protected from surprise bills in emergencies or when you didn’t choose your provider. Doctors and facilities can’t send you surprise bills in these cases.
- Certain services at in-network facilities: If you’re treated at an in-network hospital or surgical center, some providers — such as those delivering emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services — may be out-of-network. They can’t balance bill you and can’t ask you to waive your protections.
Texas law also bans balance billing for services by out-of-network providers at in-network facilities, including diagnostic imaging and lab services tied to care from in-network providers.
Your Rights
You never have to give up your protections. You also don’t have to get care from out-of-network providers. You can choose in-network care.
When balance billing protections apply, your health plan is generally required to:
- Pay out-of-network providers and facilities directly
- Ensure you only pay your share — like copayments, coinsurance, and deductibles
- Cover emergency services without requiring prior approval
- Base your cost-sharing on in-network rates and show those amounts in your explanation of benefits
- Count what you pay toward your deductible and out-of-pocket maximum
Need Help?
If you think you’ve been wrongly billed, contact:
- Centers for Medicare and Medicaid Services: 800-633-4227
- Texas Department of Insurance: 800-252-3439
Learn more at:
