Texas Patients' Right to Timely Billing

If you have health insurance, or any other kind of health care reimbursement plan, you expect your coverage to pay for much of your health care costs.

But all plans have a deadline for submitting claims. What happens if your doctor or hospital doesn't get around to billing you until after the deadline passes? You could be stuck for the entire bill.

That's why I passed the Texas Healthcare Timely Billing Law. It prohibits a healthcare provider from billing you later than the first day of the 11th month after the date of service, or the date required by any agreement between the provider and the insurer, whichever is sooner.

If a provider bills you after the deadline set by this law, the penalty is that they can only collect what would have been your portion of the bill had they billed on time. It does not matter what kind of insurance or reimbursement plan you have.

In other words, if they bill you late, the loss is on them.

What should I do if a provider bills me late?

Even though I passed this law all the way back in 1999, there are still some providers who don't follow it.

I've heard that some providers will try to guilt you into paying, even though they were at fault for not following the billing law. There are even consultants who recommend this when trying to collect lost revenue from sloppy office practices.

Don't fall for it. You are not responsible for paying more than what would have been your share. And legally, they shouldn't even be billing you after the deadline.

If you have a problem, it's always best to try to resolve the issue with the provider first. You might print this page, which includes a copy of the law below.

If you can't resolve this, you can turn to the state agency that regulates the particular provider. For doctors, it's the Texas Medical Board. For hospitals, it's the Texas Health and Human Service Commission.

Here's an article on one recent case by Houston Chronicle columnist Michael Taylor: Got a very late medical bill? Texas law says it may not be owed.

I have posted this law as a public service so that you will know your rights under the law. However, since I no longer serve in public office, nor am I an attorney, I cannot personally help you pursue your rights under this law. I'm happy to try to answer any questions you have but I cannot give you legal advice.

Texas Healthcare Timely Billing Law

Texas Civil Practice and Remedies Code
Section 146.001. Definitions.

In this chapter:

(1) "Health benefit plan" means a plan or arrangement under which medical or surgical expenses are paid for or reimbursed or health care services are arranged for or provided. The term includes:

(A) an individual, group, blanket, or franchise insurance policy, insurance agreement, or group hospital service contract;

(B) an evidence of coverage or group subscriber contract issued by a health maintenance organization or an approved nonprofit health corporation;

(C) a benefit plan provided by a multiple employer welfare arrangement or another analogous benefit arrangement;

(D) a workers' compensation insurance policy; or

(E) a motor vehicle insurance policy, to the extent the policy provides personal injury protection or medical payments coverage.

(2) "Health care service provider" means a person who, under a license or other grant of authority issued by this state, provides health care services the costs of which may be paid for or reimbursed under a health benefit plan.

Section 146.002. Timely Billing Required.

(a) Except as provided by Subsection (b) or (c), a health care service provider shall bill a patient or other responsible person for services provided to the patient not later than the first day of the 11th month after the date the services are provided.

(b) If the health care service provider is required or authorized to directly bill the issuer of a health benefit plan for services provided to a patient, the health care service provider shall bill the issuer of the plan not later than:

(1) the date required under any contract between the health care service provider and the issuer of the health benefit plan; or

(2) if there is no contract between the health care service provider and the issuer of the health benefit plan, the first day of the 11th month after the date the services are provided.

(c) If the health care service provider is required or authorized to directly bill a third party payor operating under federal or state law, including Medicare and the state Medicaid program, the health care service provider shall bill the third party payor not later than:

(1) the date required under any contract between the health care service provider and the third party payor or the date required by federal regulation or state rule, as applicable; or

(2) if there is no contract between the health care service provider and the third party payor and there is no applicable federal regulation or state rule, the first day of the 11th month after the date the services are provided.

(d) For purposes of this section, the date of billing is the date on which the health care service provider's bill is:

(1) mailed to the patient or responsible person, postage prepaid, at the address of the patient or responsible person as shown on the health care service provider's records; or

(2) mailed or otherwise submitted to the issuer of the health benefit plan or third party payor as required by the health benefit plan or third party payor.

Sec. 146.003. Certain Claims Barred.

(a) A health care service provider who violates Section 146.002 may not recover from the patient any amount that the patient would have been entitled to receive as payment or reimbursement under a health benefit plan or that the patient would not otherwise have been obligated to pay had the provider complied with Section 146.002.

(b) If recovery from a patient is barred under this section, the health care service provider may not recover from any other individual who, because of a family or other personal relationship with the patient, would otherwise be responsible for the debt.

Section 146.004. Disciplinary Action Not Authorized.

A health care service provider who violates this chapter is not subject to disciplinary action for the violation under any other law, including the law under which the health care service provider is licensed or otherwise holds a grant of authority.

The source for all information on this page is Texas Legislature Online, the web site of the Texas Legislature. The information was revised most recently on March 28, 2024. It remains up to date until any changes are made by the Texas Legislature during its 2025 legislative session.