About What we do Who we serve Our people News Careers Patients Contact

Your rights and protections against surprise medical bills

When you get emergency care, or are treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing, sometimes called balance billing.

What balance billing is

When you see a doctor or other provider, you may owe certain out-of-pocket costs — a copayment, coinsurance or deductible. You may owe more if you see a provider or facility that isn’t in your plan’s network. “Out-of-network” providers may be permitted to bill you for the difference between what your plan pays and the full amount charged. This is balance billing, and it is likely more than the in-network cost for the same service. “Surprise billing” is an unexpected balance bill — it happens when you can’t control who is involved in your care, such as an emergency, or when a specimen taken at an in-network facility is examined by an out-of-network pathologist.

You are protected from balance billing for

Emergency services. If you have an emergency medical condition and get emergency services from an out-of-network provider or facility, the most they can bill you is your plan’s in-network cost-sharing amount. This includes services you may get after you are stabilized, unless you give written consent and give up your protections.

Certain services at an in-network hospital or ambulatory surgical center. When you get services from an in-network facility, certain providers there may be out-of-network. For pathology, anesthesia, radiology, laboratory, emergency medicine, neonatology, and assistant-surgeon, hospitalist or intensivist services, the most those providers can bill you is your plan’s in-network cost-sharing amount. They can never ask you to give up these protections. Pathology services — the work this practice performs — are always protected: we will never ask you to waive your balance-billing protections.

Texas law. If your health plan is regulated by the State of Texas, Texas Senate Bill 1264 gives you equivalent protections against balance billing in emergencies and for out-of-network providers at in-network facilities, enforced by the Texas Department of Insurance.

When balance billing isn’t allowed, you also have these protections

• You are only responsible for your share of the cost — the copayments, coinsurance and deductible you would pay if the provider or facility were in-network. Your plan pays out-of-network providers and facilities directly.
• Your plan generally must cover emergency services without prior authorization, cover emergency services from out-of-network providers, base what you owe on what it would pay an in-network provider (shown in your explanation of benefits), and count what you pay toward your deductible and out-of-pocket limit.

If you don’t have insurance, or pay for care yourself

You have the right to a good faith estimate of the expected charges before you schedule a service, or on request. If the bill you receive is at least $400 more than the estimate, you can dispute it within 120 days. Ask us for an estimate before you schedule, and keep a copy.

If you believe you’ve been wrongly billed

Start with us — most billing questions resolve with one call: 817.293.4304. For federal protections, contact the No Surprises Help Desk at 1-800-985-3059 or visit cms.gov/nosurprises. For plans regulated by Texas, contact the Texas Department of Insurance at 1-800-252-3439 or tdi.texas.gov.

© 2026 Texas Pathology Group. All rights reserved. Privacy Notice of privacy practices No Surprises Act Terms of service