You’re Protected from Out-of-Network Surprise Billing

We've All Been There

You get a bill for a medical procedure you thought was in-network but wasn’t. A law passed on Jan. 1, 2020, protects you from balance billing from out-of-network (OON) providers in certain situations.

Balance billing, or surprise billing, is when a medical provider or facility bills a patient the difference between the provider’s charge and the insurance-allowed amount. The new law prohibits balance billing by:

• OON providers and facilities who provide emergency care,
• OON providers who provide care at an in-network hospital, and
• OON lab and diagnostic services that are related to an in-network hospital stay.

These providers may not bill patients any amount greater than the copayment, coinsurance and deductible.

If you have an elective service and are treated by a OON provider, you may be asked to sign a balance billing waiver form (pdf). They must ask you to sign this form at least 10 days before you have the service. If you sign the waiver, you may be balance billed - that’s why it’s important to thoroughly review all the paperwork your providers ask you to sign.

What Should You Do If You Get a Surprise Bill?

TRS-ActiveCare Participants: If you get a surprise bill, call a Blue Cross and Blue Shield of Texas Personal Health Guide at 1-866-355-5999.

TRS-Care Standard Participants: If you get a surprise bill, call a Blue Cross and Blue Shield of Texas Personal Health Guide at 1-866-355-5999.

The customer service agent will contact the billing provider to remind them that, for dates of service from Jan. 1, 2020 and later, out-of-network providers may no longer balance bill patients. If the provider has further questions, they will be directed to contact the Texas Department of Insurance (TDI).

TRS-Care Medicare Advantage Participants: Under your plan, you are not responsible for any balance billing when seeing health care providers who have not opted out of Medicare.

Avoiding Surprise Bills

Stay In-Network: Staying in-network means lower out-of-pocket costs for you, because providers and facilities cannot charge more than your plan’s allowable amounts for covered services. It’s important to stay in-network when planning for any kind of medical care.

• TRS-ActiveCare participants can find in-network providers and facilities through the BCBSTX TRS-ActiveCare Provider Finder® directory. Remember if you’re enrolled in TRS-ActiveCare Primary or TRS-ActiveCare Primary+, you  can only use in-network providers for your care.
• TRS-Care Standard participants can search and find in-network providers and facilities through BCBSTX TRS-Care Standard Provider Finder®.
• TRS-Care Medicare Advantage Participants: Under your plan, you are not responsible for any balance billing when seeing health care providers who have not opted out of Medicare.

Review Provider Paperwork: In certain situations, a provider may request you sign a balance billing waiver before providing care. If you sign the waiver, you may be balance billed. Be sure to read through all the forms the provider gives you before signing it.

Plan Ahead: It’s important to plan ahead and know the appropriate place to seek care when you need it. Learn about your options for care such as TRS- Virtual Health for non-urgent medical needs, in-network urgent care centers for immediate health care needs or in-network ERs for life-threatening illnesses. Knowing your options before you get sick can help reduce your chance of getting a surprise bill.

Get an Estimate: Ask your provider for a written estimate of the price for your treatment or procedure.