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.
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).