Texas Timely Billing Law

What is the Texas Timely Billing Law?

This law requires that health care providers in Texas bill a patient no later than the first day of the 11th month after services were provided. If you receive a medical bill over 11 months (even by 1 day) after the service then you DO NOT have to pay it. 

This includes:

• “Charges a patient could be reimbursed for by a health plan.”

• “Charges that a patient would not have owed if the provider billed them in a timely fashion.” 

What About Health Share Pans?

The written law does not specifically mention health-share plans, however I reached out to the former Texas State Representative, Scott Hochberg, who wrote the law.

Here is his response:

“The definition of health benefit plan is used only to specify some exceptions, such as when the contract between a health benefit plan and the provider specifies a different amount of time as a deadline for billing. So it doesn't seem to matter whether your plan is included in that or not - the provider's obligation to bill in a timely manner is absolute, and the penalty for not doing so is that they can't collect any more than you would have paid had the bill been sent timely.”

“I spoke with the gentleman in charge of consumer complaints for the Texas Medical Board. He told me that they do hear of cases of late billing, such as yours, and they enforce the existing law with no distinction between the type of reimbursement plan or insurance plan involved. Based on the information you provided, you should not have been billed for the charge, and once you explained your situation, they should have withdrawn the charge.”

What Should You Do if this Happens to You?

CALL THE MEDICAL PROVIDER WHO SENT THE BILL!!!

Unfortunately many providers are not aware of this law, and there is no penalty for providers who do send a bill after 11 months. It’s up to the patient to know their rights. 

Call the office and ask to speak to the billing manager, and make them aware of the law. If they aren’t aware of the law then they will most likely tell you they need to talk to the provider. If the provider is also not aware of the law they may consult with their lawyer (depending on the size of the bill). Do not let this scare you. They are just doing their due diligence. 

Their lawyer SHOULD tell them that they cannot collect payment. If you are sent to collections, then make the collections agent aware of the law and the date of bill.