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Senate Bill 1264

Texas Senate Bill 1264 is designed to help end surprise medical bills. This legislation went into effect Wednesday, January 1st. What it says is a bit confusing, even to those who sell health coverage insurance. The new law mandates that the non-network physician or provider cannot bill the patient. In addition the bill say’s the patient has no financial responsibility for an amount greater than the patient's health care plan calls for. That includes an applicable co-payment, coinsurance or deductible. In other words, it appears as if those surprise bills that so many have received, may no longer be sent to the patient. It says insurance companies and medical providers can enter into arbitration to negotiate a payment — and state officials would oversee that process.  This surprise medical billing typically happens when someone with health insurance goes to a hospital during an emergency and that hospital maybe out of network. It also happens if a patient goes to an in-network hospital but the patient's doctors or medical providers are not in network. Sometimes insurance companies and medical providers won't agree on what is a fair price for that care, and patients end up with a hefty surprise medical bill.  These new state protections won’t apply to every insured Texan. SB 1264 only applies to those with a state-regulated insurance plan. Also it is important to note the new bill is not retroactive – in other words –patients over billed before the new law became effective on January 1st        will not be helped by this legislation but that patient might qualify for mediation through the Texas Department of Insurance. Find out if that statement prior to January 1st qualifies to be heard by the Texas Department of Insurance. Simply go to their website –The address is or you can call 1-800-252-3439


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