Surprise bills and ambulance bills in Texas
For out-of-network emergency care, out-of-network doctors and other facility-based providers at an in-network hospital or other facility, and out-of-network lab and imaging services, you owe only your in-network copay, coinsurance and deductible.
Checked against official sources: October 30, 2026.
What Texas adds
- State law
Texas balance billing law and ground ambulance law
Law: S.B. 1264, 2019; S.B. 2476, 2023; Tex. Ins. Code 1301.155, 1301.164, 1301.165, 1301.166, 1271.159; ch. 1467
- Which plans it covers
Health plans regulated by Texas: HMO plans and PPO/EPO plans regulated by the Texas Department of Insurance (the insurance card shows "DOI" or "TDI"), Employees Retirement System of Texas plans (such as HealthSelect), TRS-ActiveCare and TRS-Care Standard, Texas Farm Bureau plans, and employer plans that opted in (the card may show "TXI"). Most self-funded employer plans and Medicare are not covered by state law.
- What it adds
For out-of-network emergency care, out-of-network doctors and other facility-based providers at an in-network hospital or other facility, and out-of-network lab and imaging services, you owe only your in-network copay, coinsurance and deductible. For non-emergency care, an out-of-network provider may bill you more only if you chose that provider in writing in advance after getting a written disclosure of the projected amounts.
- Ground ambulance
The state protects you
If you have a state-regulated plan, an out-of-network ground ambulance (not an air ambulance) may bill you only your copay, coinsurance and deductible. Your plan pays the ambulance the rate set by the local government where the service started or, if none was filed, the lesser of the billed charge or 325% of Medicare. This law is set to expire September 1, 2027. No Texas law limits ground ambulance bills for people without insurance.
Law: Tex. Ins. Code 1271.159, 1301.166
Law: Tex. Ins. Code 1301.155, 1301.164, 1301.165, 1301.166, 1271.159; ch. 1467
Itemized bills and price estimates in Texas
Texas law gives you a right to an itemized bill within 30 days.
When a health care provider (including a hospital, but not a federally qualified health center) asks you to pay, it must send a written itemized bill with a plain-language description of each service and supply, any billing codes sent to your insurer, what the insurer was billed and paid, and what you owe for each item. It must send the bill no later than 30 days after it gets final payment from your insurer. It may send it through a patient portal only if you have an active portal account; otherwise it must mail, email or hand you a copy as you choose. You can ask for another copy later. The provider may not pursue debt collection until it complies. Separately, a hospital, surgery center, birthing center or freestanding emergency room must give you an itemized statement if you ask within 1 year after discharge, within 10 business days of your request.
Law: Tex. Health & Safety Code 185.001, 185.002; Tex. Health & Safety Code 324.101(e)
Price estimates
Before an elective hospital stay or a non-emergency outpatient surgery or other service is scheduled, a hospital, surgery center, birthing center or freestanding emergency room must give you an estimate of its billed charges if you ask. It must email the estimate within 5 business days and tell you how to dispute final charges that are $400 or more above the estimate. Facilities with $10 million or more in yearly revenue must also post their standard charges and a consumer-friendly list of shoppable services.
Law: Tex. Health & Safety Code 324.101(d), (d-1); ch. 327
Where to complain in Texas
- Health insurance: Texas Department of Insurance · 1-800-252-3439
A state-regulated health plan denied a claim, or you got a surprise bill or out-of-network ambulance bill the state law protects you from. - Hospital licensing: Texas Health and Human Services Commission, Health Care Facilities Regulation (complaint hotline) · 1-800-458-9858
A hospital or other licensed facility did not follow state billing rules, such as the itemized bill rules. - Attorney general: Texas Attorney General, Consumer Protection Division
A debt collector or business used unfair or deceptive practices.
Free tools, letters and checklist
Questions about medical bills in Texas
Am I protected from ground ambulance bills in Texas?
If you have a state-regulated plan, an out-of-network ground ambulance (not an air ambulance) may bill you only your copay, coinsurance and deductible. Your plan pays the ambulance the rate set by the local government where the service started or, if none was filed, the lesser of the billed charge or 325% of Medicare.