Patient Rights

Texas Patient Billing Rights

Know your rights as a patient in Texas. From surprise billing protections to financial assistance programs, here's what the law says about your medical bills.

Surprise Billing Financial Assistance Additional Rights File a Complaint

Protection

Surprise Billing Protections

SB 1264 (Out-of-Network Billing) — Texas was a pioneer in surprise billing reform. SB 1264 (2019) protects patients from balance billing for emergency care and out-of-network providers at in-network facilities.

Texas was one of the first states to enact strong surprise billing protections (effective Jan 1, 2020).
Patients at in-network facilities who receive care from out-of-network providers pay only their in-network cost-sharing amount.
Covers emergency care, and non-emergency care at in-network facilities where patients didn't choose the out-of-network provider.
Applies to most state-regulated health plans (HMO and PPO plans regulated by TDI).
Provider-insurer disputes go through mandatory mediation, with binding arbitration if mediation fails.

What this means for you

If you receive a surprise out-of-network bill, you are not responsible for the balance beyond what you'd pay for in-network care. Contact your insurer and reference the SB 1264 (Out-of-Network Billing) to dispute any balance bill.

Review your bill →

Assistance

Financial Assistance & Charity Care

Under Federal 501(r) Requirements, hospitals in Texas must provide financial assistance to qualifying patients.

Nonprofit hospitals in Texas must have financial assistance policies and make them available to patients.
There is no state-mandated income threshold — each hospital sets its own eligibility criteria.
Hospitals must provide a written description of their financial assistance program upon request.
Federal 501(r) requirements apply to nonprofit hospitals (must publicize FA policy, limit charges for FA-eligible patients).
Uninsured patients can negotiate directly with hospitals; many offer self-pay discounts of 30-60%.

How to apply

Ask the hospital's billing department for a financial assistance application.
Gather proof of income (pay stubs, tax return, benefit letters).
Submit the application — you can often do this even after receiving a bill.
If denied, appeal the decision and contact your state insurance department.

Know Your Rights

Additional Patient Rights in Texas

Beyond surprise billing and financial assistance, Texas law provides these important protections.

Itemized Bills

Texas patients have the right to request and receive an itemized bill within 30 days. This must include each service, supply, and medication charged.

Dispute Process

You can file a complaint with the Texas Department of Insurance for billing disputes. TDI offers a mediation program for out-of-network billing disputes.