Texas No Surprises Act Out-of-Network Provider Balance Billing

Since Jan. 1, 2020, Blue Cross and Blue Shield of Texas members with state-regulated (fully insured) health insurance have been protected against some surprise medical bills, also called balance bills with the passage of the Texas No Surprises Act.

Who is Covered

The law applies to members who meet one of the following:

  • Their member ID card has a "TDI" printed on it.
  • They are covered by the Employee Retirement System (ERS).
  • They are covered by the Teachers Retirement System (TRS).

This law does not apply to:

  • Self-funded employer-sponsored health plans, unless the employer has opted-in to the Texas No Surprises Act, in which case their member ID card has "TXI" printed on it.
  • Medicare
  • The Federal Employee Program (FEP®)
  • Plans issued by health plans outside Texas

If you are not sure what type of plan the member has, please contact the customer service number on the back of the member ID card.

What Services are Subject to the Texas No Surprises Act

  • Services provided by out-of-network providers who practice at in-network hospitals, birthing centers, ambulatory surgical centers and free-standing emergency medical care facilities.
  • Emergency services and supplies provided by out-of-network physicians and facilities, including hospitals, free-standing emergency medical care facilities and ground ambulance companies.
  • Out-of-network diagnostic imaging services and laboratories that provider services in connection with a service from an in-network provider.

Implications of the Bill for Out-of-Network Providers

The new law bans providers from sending balance bills to members in those cases. Instead, providers can work directly with the health plans to agree on payment for those bills.

Dispute Resolution: In the event, an out-of-network provider and insurer cannot agree on payment for services provided, an independent reviewer selected by the out-of-network provider and insurer is used to help resolve the payment dispute.

Waiver: Members covered by the Texas No Surprises Act can opt to have services provided by out-of-network providers by signing the Balance Billing Waiver form. This form waives the protections against balance billing and allows the provider to bill members over deductible, copayments and coinsurance. The waiver cannot be used in an emergency or when an out-of-network provider was assigned to a case, such as an anesthesiologist during surgery.

Please help your patients and our members by referring or recommending BCBSTX in-network providers. Refer to Find a Doctor or Hospital on the provider website.

Have questions? Contact our Provider Services line at 1-800-451-0287.

For more information, refer to