Texas Health Insurance Mediation Request Form
Description
How to fill out Texas Health Insurance Mediation Request Form?
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FAQ
Send In a Written Notice for Billing Disputes Account identification information. Identification of the specific bill (or bills) in dispute. A statement that you believe the bill is in error. The reason(s) why the bill is disputed.
File a complaint with the Health Facility Compliance Group at the Texas Department of State Health Services (DSHS). This is the agency ensuring that hospitals and health facilities are providing safe, responsible care. DSHS will also investigate claims of improper hospital billing.
You are protected from balance billing for: Additionally, Texas law protects patients from surprise medical bills in emergencies and when a patient receives covered medical services from an out-of-network provider at an in-network facility.
Submitting a Complaint Against Healthcare Facilities (Except Substance Abuse (Chemical Dependency) Treatment or Narcotic or Opioid Treatment Facilities) Complaint hotline: 1-800-458-9858, Option 5. Email: hfc.complaints@hhs.texas.gov. Fax: 833-709-5735. Mailing address: Health and Human Services Commission.
As of January 1, 2022, the No Surprises Act (NSA) protects you from surprise billing if you have a group health plan or group or individual health insurance coverage. The NSA is a federal law that prohibits balance billing for out-of-network, self-pay, and uninsured patients from certain surprise medical bills.
Texas has a "timely billing" law. It requires health care service providers to bill a patient no later than the first day of the 11th month after services were provided.