Out-of-Network Provider Surprise Billing Senate Bill (SB) 1264
Starting Jan. 1, 2020, Blue Cross and Blue Shield of Texas (BCBSTX) members with state-regulated (fully insured) health insurance have new protections against some surprise medical bills, also called balance bills with the passage of SB1264.
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:
- Other self-funded employer-sponsored health plans
- 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 Applicable
- 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 and free-standing emergency medical care facilities.
- Out-of-network diagnostic imaging and laboratory services that are provided 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.
For more information, refer to
- SB1264 - Texas Surprise Billing Law - Out-of-Network Provider Frequently Asked Questions
- Surprise Medical Bills Member Video on the BCBSTX website
- Surprise Medical Bills Provider Video on the BCBSTX provider website
- Texas Department of Insurance website