How to avoid receiving a surprise medical bill

You may receive a surprise medical bill, also known as balance billing, from a doctor or facility that is not in your health plans network. Texas law protects patients with state-regulated health insurance from surprise bills in emergencies and when they didnt have a choice of doctors. But if your health plan isnt regulated by the state, heres how to avoid surprise bills.

Emergencies and after-hours care

For life-threatening emergencies, get care as soon as possible. For less serious illnesses and injuries:

• Know in advance which emergency rooms and urgent care centers nearby are in your network.
• Be careful of places that say "accept" or "take" all insurance. Call the number on your insurance card to make sure the facility is within your network.
• Understand the difference between a freestanding emergency room and an urgent care clinic. Freestanding emergency rooms have the word "emergency" in their name. They are less likely to be in your network and may not accept Medicare or Medicaid.
• For minor problems, consider calling the Nurse Advice Line, a commercial clinic visit, or a virtual visit.

Surgeries

For planned procedures, including surgeries:

• Use hospitals and surgeons in your network.
• Ask which laboratories or other doctors will be involved in your health care, such as the anesthesiologist or radiologist. Find out if they participate in your network. Even if a hospital is in your network, some of the doctors who work there may not be.
• Ask your health plan if you need to get prior approval for the procedure.

Doctor visits

Use doctors in your health plans network and Medical Billing Services. Before going to a specialist, ask your health plan if you need to get a recommendation from your GP. Make sure the specialist is in your plans network.