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.

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).  

How to apply for mediation

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