Insurance Information

• the facility is a freestanding emergency medical care facility;
• the facility charges rates comparable to a hospital emergency room and may charge a facility fee;
• a facility or a physician providing medical care at the facility may be an out-of-network provider for the patient's health benefit plan provider network; and
• a physician providing medical care at the facility may bill separately from the facility for the medical care provided to a patient; and
• the facility is an out-of-network provider for all health benefit plans.

• The facility is not recognized by Medicare or Medicaid.
• The facility is required to disclose the price the facility charges for the test or vaccine and any facility fees, supply costs, and other costs associated with the test or vaccine in accordance with the disclosure requirement for an infectious disease based on a state of disaster declared under Chapter 418, Government Code.

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 surprise billing. In these cases, you shouldn't be charged more than your plan's copayments, coinsurance and/or deductible.

What is "surprise billing" (sometimes called "balance billing")?
When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, like a copayment, coinsurance, or deductible. You may have additional costs or have to pay the entire bill if you see a provider or visit a health care facility that isn't in your health plan's network. "Out-ofnetwork" 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" is an unexpected balance bill. This 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.

Department of State Health Services
Patient Quality Care Unit - Health Facility Compliance
P.O. Box 149347, Mail Code 1979
Austin, Texas 78714-9347
Telephone: (888) 973-0022

Visit https://www.cms.gov/ for more information about your rights under federal law.
Visit https://www.tdi.texas.gov/medical-billing/surprises-balance-billing.html for more information about your rights under Texas Law.