No Surprise Medical Bills

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 balance billing. In these cases, you shouldn’t be charged more than your plan’s copayments, coinsurance and/or deductible.

Balance Billing

  • What is “balance billing” (sometimes called “surprise billing”)?

    When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, like a copaymentcoinsurance, or deductible. If you see a provider or visit a health care facility that isn’t in your health plan’s network, you may have additional costs or have to pay the entire bill.

    “Out-of-network” means providers and facilities that haven’t signed a contract with your health plan to provide services. Out-of-network providers may be allowed to bill you for the difference between what your plan pays and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your plan’s deductible or annual out-of-pocket limit. 

    “Surprise billing” can happen when you can’t control who is involved in your care—like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider. Surprise medical bills could cost thousands of dollars depending on the procedure or service. 

  • At UTMB Health, you’re 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 we will bill you is your plan’s in-network cost-sharing amount (such as copayments, coinsurance, and deductibles). You will not be balance billed for these emergency services. This includes services you may get after you’re in stable condition, unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services. 

    CERTAIN SERVICES AT AN IN-NETWORK HOSPITAL OR AMBULATORY SURGICAL CENTER 

    When you get services from an in-network hospital or ambulatory surgical center, it is possible some providers may be out-of-network. In these cases, the most these out-of-network providers will bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers can’t balance bill you and may not ask you to give up your protections not to be balance billed. 

    If you get other types of services at these in-network facilities, out-of-network providers can’t balance bill you, unless you give written consent and give up your protections. 

    We'll never require you to give up your protections from balance billing. You also aren’t required to get out-of-network care. You can choose a provider or facility in your plan’s network. 

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

    You’re only responsible for paying your share of the cost (like the copayments, coinsurance, and deductible that you would pay if the provider or facility was in-network). Your health plan will pay any additional costs to out-of-network providers and facilities directly. 

    Generally, your health plan must: 

    • Cover emergency services without requiring you to get approval for services in advance (also known as “prior authorization”).
    • Cover emergency services by out-of-network providers.
    • Base what you owe the provider or facility (cost-sharing) on what it would pay an in-network provider or facility and show that amount in your explanation of benefits.
    • Count any amount you pay for emergency services or out-of-network services toward your in-network deductible and out-of-pocket limit.

Need an Estimate?

You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost. For more information please email your request to patientestimates@utmb.edu or request an estimate for clinical services.

Need Assistance?

If you think you’ve been wrongly billed:  

You may contact our UTMB Health Customer Service Office at (877) 463-0103 or (409) 515-7049, or send email to rcobilling.customerservice@utmb.edu

If you have a State of Texas regulated insurance plan or have coverage through the Texas employee or Teacher Retirement System, then you may have additional protections regarding surprise medical bills.  For more information, please visit   https://www.tdi.texas.gov/medical-billing/index.html.

For information or assistance with balance billing questions from the State of Texas Department of Insurance, visit https://www.tdi.texas.gov/medical-billing/surprise-balance-billing.html.

Visit www.cms.gov/nosurprises/consumers for more information about your rights under federal law. The federal phone number for information and complaints is: 1 (800) 985-3059.

Insurance and Billing

  • Billing Inquiries – Single point of customer service.

    UTMB Health is also pleased to offer a single point of customer service to our patients for services provided at our facilities by UTMB providers, so that we may answer many of your billing questions with one phone number, instead of requiring separate phone calls to different billing offices for hospital/clinic fees and health care provider charges.

     You may contact our UTMB Health Customer Service Office at (877) 463-0103 or (409) 515-7049, or click to send email*

    In addition, when you check in at any of our clinics, our Patient Services Specialists will be able to discuss outstanding balances and conveniently assist you by collecting payments toward any balance due, helping you stay current with your health care financial responsibilities.

    * Please see information below regarding questions about fees from non-UTMB care providers.

  • Care Management

    UTMB is an academic teaching facility, and as such, you may see a variety of care providers during your stay with us. Care managers are assigned to medical teams to address needs during your hospital stay. These needs may include ensuring that high-quality care is delivered in an efficient manner, proactively planning for your discharge early during your hospital stay, and identifying solutions to discharge barriers that could otherwise delay your return home.

    Care managers are available Monday–Friday, 8 a.m.–5 p.m. If you anticipate problems returning home after discharge, please contact (409) 772-1541 so your care manager can speak with you about your concerns.

  • Charity Care and Financial Assistance Policy

    Current UTMB patients are eligible to apply for financial assistance related to services already provided at UTMB. Existing UTMB and non-UTMB patients may contact Financial Counseling at (409) 772-6464 to learn about the application process.

    Patients are not eligible for financial assistance if they a) have third party insurance (excluding patients with traditional Medicare); or b) if they are eligible for another third party program such as Medicaid, County Indigent Health Programs (CIHCP), etc; or c) are not Texas residents. Patients seeking treatment for certain elective, non-emergent procedures or outpatient services will be considered full pay patients, and payment in full will be expected at or before the time services are rendered.

    Qualified applicants whose income and calculated assets are below 200% of the levels indicated in the Federal Poverty Guidelines (found at http://aspe.hhs.gov/poverty/) will qualify for a 100% charity discount on any balances.  Qualified applicants whose income and calculated assets are equal to or greater than 200%−but below 400% of the Federal Poverty Guidelines − will qualify for a 75% charity discount on any balances.

    The Financial Counseling Office manages the process of vetting requests for assistance. An interview/screening process conducted by the office will determine if an individual is eligible to receive discounted medical services at UTMB.

    Self-pay patients (individuals who are personally responsible for their bills because they do not have third party coverage, and do not qualify for full or partial charity care discounts) with income levels equal to or greater than 400% of Federal Poverty Guidelines may qualify for discounts up to 40% for inpatient services and 50% for outpatient services received.

  • Hospital Costs and Charges

    If you are considering a hospital procedure and are interested in an estimate of the cost, or are comparing costs among different providers, the following page offers helpful information for you, including a definition of the hospital "chargemaster." Costs and charges information.

  • Insurance Claims and Payment Policies

    All accounts are payable in full upon receipt of your statement. If you have commercial health insurance, your coverage will be verified and a claim will be filed on your behalf. Our billing departments will cooperate fully with you and your insurance company to expedite payment of your claim.  If you have assigned insurance benefits to UTMB, your insurance company has 60 days from the date the claim is filed to complete payment.

    In the event your insurance company fails to pay the claim after 60 days, it may be necessary for UTMB  to ask you to pay your hospital or physicians’ bills.

    Please remember that the patient or guarantor, not the insurance company, is responsible for the settlement of the account. Once your insurance payment has been received, any remaining balance is expected in full, within 30 days.

    If you cannot pay your patient balance in full, it may be possible to establish a payment plan. The term and payment amount is determined according to the amount owed. A customer service account specialist can assist you in establishing a payment plan. For more information, please call: 

    For payment plan information, please contact our Customer Service Office at (877) 463-0103 or (409) 515-7049 or email RCObilling.customerservice@utmb.edu

  • Insurance Network Participation Notification
    It is policy at UTMB Health for our registration staff to provide a written disclosure to all patients receiving care as to whether the services requested/received are considered in-network or out-of-network. The guidance UTMB provides is based on the information provided by the patient at the time of service, and availability of the insurance company or other provider to confirm coverage details. Disclosures are provided in the Emergency Room, inpatient areas, day surgery units, ancillary areas, and clinics.
  • Insurance Plans Accepted

    At UTMB Health, we serve patients with many types of insurance coverage, offered by many different companies and entities. UTMB and its providers accept most major health plans, which are outlined online. Remember to always check with your health insurance carrier regarding specific covered services. The list grows and changes frequently. If you don't see your insurance listed or if you have any questions, please contact us.

  • Interest Applied to Billed Services
    At this time, per its current policy, UTMB Health does not apply interest charges to bills issued for its clinical services.
  • Patient Complaints

    At UTMB Health, our goal is to care for you in a manner that consistently meets and exceeds your expectations. If we fall short of that goal, our Patient Services department is in place to provide a centralized and effective mechanism to investigate, address and hopefully resolve a given issue.

    You may contact the department by mail, phone or email:

    UTMB Health Department of Patient Services
    Route 0306
    Galveston, Texas 77555-0306
    (409) 772-4772
    patient.services@utmb.edu

  • Payment options for Patients without MyChart Access

    If you would like to make a payment on your account (for services rendered after April 6, 2013) but are not a MyChart user, please call:

    UTMB Customer Service: (877) 463-0103 or (409) 515-7049.
    We accept the following forms of payment: formsofpayment

  • Policies regarding UTMB Health’s Discounting, Pricing and Billing Procedures

    In accordance with Senate Bill 1731 (“Healthcare Transparency”) and in addition to the information offered above, UTMB posts for its patients policies on billing and collection practices. If you don’t have access to the internet or would prefer a written copy, please call (877) 463-0103 or (409) 515-7049.

    Available documentation on policies and procedures include:

    • Discounting charges for uninsured patients [See policy]
  • Requesting an Estimate

    UTMB Health is happy to provide estimates for its services, and typically  provides a response to requests in 2-3 business days. Get details and make a request.


    myChart Patient Estimate Tool

    The myChart Patient Estimate is an online tool to assist patients with an estimate based on their insurance and benefit plan. This enables the patient to create an estimate without having to call RCO and satisfies the requirement for displaying 300 shoppable services for the price transparency rule.

    Click to use the myChart Patient Estimate Tool
  • Requesting an Itemized Statement

    UTMB will mail you a monthly statement on each account on which you owe a balance. If you would like to receive a more detailed list of your hospital or professional charges, you may request an itemized statement. Our customer service account specialists can assist you via telephone, or you may submit a request for an itemized statement via email. Statements will be sent via US Mail to you at your address of record.

    For itemized bills and information, please call (877) 463-0103 or (409) 515-7049 or email RCObilling.customerservice@utmb.edu

ALERT BAR

 Contacts & Resources