|If you have health insurance that is regulated by the Texas Department of Insurance (TDI), Teachers Retirement System, or Employees Retirement System but still got a bill from a hospital or physician for a medical appointment or procedure, you may not have to have pay all, or any, of the bill! Instead, you may be able to use a process called mediation.|
What is TDI's Mediation Process?
Mediation is a process that you must request that requires your health insurer and the treatment provider to meet with a mediator to evaluate whether the amount charged by the out-of-network provider is excessive and whether the amount paid by the insurer or administrator represents the usual and customary rate for the health care or medical service or supply or is unreasonably low.
The parties are then required to determine the amount, after copayments, deductibles, and coinsurance are applied, for which an enrollee is responsible to the facility-based provider or emergency care provider. The mediation process does not require you to hire an attorney or pay the other parties' legal fees.
You most likely qualify for medical bill mediation in Texas if you:
- Have a balance bill for $500 or more;
- Have healthcare through the Teachers Retirement System (TRS), Employee Retirement System (ERS), or if your health insurance card says either DOI or Texas Department of Insurance (TDI) on it; and
- Were treated at a hospital, freestanding ER, or other facility.
You can apply for mediation by completing the following form and submitting it to TDI: http://www.tdi.texas.gov/forms/consumer/mediationform.pdf.