How to avoid getting a surprise medical bill
You can get a surprise medical bill, also called a balance bill, from a doctor or facility that isn’t in your health plan’s network. Texas law protects patients with state-regulated health insurance from surprise bills in emergencies and when they didn’t have a choice of doctors. But if your health plan isn’t regulated by the state, here’s how to avoid surprise bills.
Emergencies and after-hours care
For life-threatening emergencies, get care as quickly as possible. For less serious illnesses and injuries:
- Know in advance which emergency rooms and urgent care centers near you are in your network.
- Beware of places that say they “accept” all insurance. Watch this video to learn how to ask if a facility is in your network.
- Understand the difference between a freestanding ER and an urgent care clinic. Freestanding ERs have “emergency” in the name. They are less likely to be in your network and may not accept Medicare or Medicaid.
- For minor issues, consider a nurse line call, a visit to a retail clinic, or a virtual visit.
Surgeries
For planned procedures, including surgeries:
- Use hospitals and surgeons in your network.
- Ask what labs or other doctors will be involved in your care, such as an anesthesiologist or radiologist. Find out if they’re in your network. Even if a hospital is in your network, some of the doctors who work there might not be.
- Ask your health plan if you need their pre-approval for the procedure.
Doctor’s visits
Use doctors in your health plan’s network. Before going to a specialist, ask your health plan if you need a referral from your primary care doctor. Make sure the specialist is in your plan’s network.
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