You Have the Right to a Good Faith Estimate
You have the right to receive a Good Faith Estimate explaining how much your medical care will cost.
Under the law, health care providers need to give patients who don't have insurance or who are not using insurance an estimate of the bill for medical items and services.
- You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
- Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
- If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
- Make sure to save a copy or picture of your Good Faith Estimate.
To request a Good Faith Estimate before scheduling, call our billing office at 713-597-5131.
For questions or more information about your right to a Good Faith Estimate, visit cms.gov/nosurprises or call 1-800-985-3059.
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 (sometimes called surprise billing).
What is balance billing?
When you see a doctor or other health care provider, you may owe certain out-of-pocket costs — 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-of-network means providers and facilities that haven't signed a contract with your health plan. Out-of-network providers may be permitted to bill you for the difference between what your plan pays and the full amount charged for a service. This is called balance billing. Balance billing may be more than in-network costs for the same service, and it might not count toward your plan's deductible or annual out-of-pocket limit.
Surprise billing is an unexpected balance bill — for example, when you can't control who is involved in your care, such as during an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider.
You are protected from balance billing for:
Emergency services. If you have an emergency medical condition and get emergency services from an out-of-network provider or facility, the most they can bill you is your plan's in-network cost-sharing amount. You cannot be balance billed for these emergency services, including services you may get after you're in stable condition, unless you give written consent and give up your protections.
Certain services at an in-network hospital or ambulatory surgical center. When you get services from an in-network facility, certain providers there may be out of network. In these cases, the most those providers can bill you is your plan's in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, and intensivist services. These providers cannot balance bill you and may not ask you to give up your protections.
If you get other types of services at these in-network facilities, out-of-network providers cannot balance bill you unless you give written consent and give up your protections.
You are never required to give up your protections from balance billing. You also are not required to get out-of-network care. You can choose a provider or facility in your plan's network.
When balance billing isn't allowed, you also have these protections:
- You are only responsible for paying your share of the cost — the copayments, coinsurance, and deductible you would pay if the provider or facility were in-network. Your health plan pays out-of-network providers and facilities directly.
- Your health plan generally must cover emergency services without requiring prior authorization, cover emergency services by out-of-network providers, base what you owe on what it would pay an in-network provider, and count any amount you pay toward your deductible and out-of-pocket limit.
Texas Protections
Texas law (Tex. Ins. Code Ch. 1467, SB 1264) provides additional protections against balance billing for patients covered by state-regulated health plans, including the Texas Employees Group Benefits Program, TRS, and state-regulated commercial plans. Under Texas law, out-of-network providers generally may not bill you more than your in-network cost-sharing amount for emergency care and for certain non-emergency care at in-network facilities.
Texas law also provides a mediation and arbitration process for disputes between providers and health plans, in which the patient is not a party.
If You Believe You Have Been Wrongly Billed
Call our billing office first at 713-597-5131. We will review the charge with you.
You may also:
- Contact the federal No Surprises Help Desk at 1-800-985-3059 or visit cms.gov/nosurprises
- Contact the Texas Department of Insurance at 1-800-252-3439 or visit tdi.texas.gov
- Initiate the patient-provider dispute resolution process if you received a Good Faith Estimate and your final bill is at least $400 higher
This notice summarizes your rights. It does not modify the terms of your health plan. Consult your plan documents or your insurer for coverage specifics.