Health Insurance

Surprise Bills

What is mediation?

Mediation is a process you can request that requires your health insurer and out-of-network doctor or other providers to meet with a mediator to assess your bill.

  • This group evaluates whether the amount charged by the out-of-network provider is excessive and whether the amount paid represents the usual and customary rate for the health care or medical service or supply, or if it is unreasonably low.
  • They then have to determine the amount (after copayments, deductibles, and coinsurance are applied) that you are responsible for paying to the facility-based provider or emergency care provider.
  • You do not have to hire an attorney or pay for the other parties’ legal fees.
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You most likely qualify for medical bill mediation if you:

  • Have a balance bill for $500 or more;
  • Were treated at a hospital, freestanding ER, or other facility; and
  • Have healthcare through TRS or ERS or your health insurance card displays DOI or Texas Department of Insurance (TDI).  
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How to apply for mediation

You can apply for mediation by filling out TDI’s mediation form and submitting it to TDI.