Billing Inquiry & Dispute FAQ

• Some claims take a long time to finish. Insurance processing, appeals, and corrections can take months or years.
• We bill you once your balance is final.
• Texas law gives providers up to four years to pursue an unpaid balance.

Source: Texas Civil Practice and Remedies Code § 16.004 (four-year limitations period for debts)

• No. Texas's timely billing law only stops a provider from collecting two things: amounts your insurance would have paid, and amounts you wouldn't otherwise have owed.
• Your own share of the cost (copay, deductible, coinsurance, or self-pay charge) is still owed.

Source: Texas Civil Practice and Remedies Code Chapter 146 (§ 146.002 billing deadlines; § 146.003 what a late bill limits)

• Your original bill was sent within the time Texas law requires. Not responding to it doesn't cancel or reduce the balance.
• We will keep sending statements until the balance is paid or a payment plan is set up.
• Unpaid balances may be referred to a collection agency.
• To avoid that, call us at (469) 896-0398 to pay or set up a payment plan.

Sources: Texas Civil Practice and Remedies Code § 146.002 (billing deadlines); Texas Finance Code Chapter 392 (Texas Debt Collection Act)

• Yes. Under Texas law, a bill counts as sent on the date it is mailed to the address in our records, whether or not you received it.
• We also send notices by text and email to the contact information you gave us. A blocked number, full inbox, or spam filter doesn't cancel the balance.
• It's your responsibility to keep your address and contact information up to date with us.
• Call us at (469) 896-0398 to confirm your contact information, get a copy of your bill, or set up a payment plan.

Source: Texas Civil Practice and Remedies Code § 146.002(d) (when a bill counts as sent)

• Yes. You owe the portion you would have paid if insurance had been billed, such as your copay.
• We do not bill you for any amount your insurance would have covered.

Source: Texas Civil Practice and Remedies Code § 146.003 (what a late bill limits)

• We submitted your claim to the insurance you gave us.
• If that plan denied the claim, the balance is your responsibility.
• If you give us your correct insurance now, we will submit the claim to that plan where possible.

Sources: Texas Civil Practice and Remedies Code § 146.002; Texas Insurance Code § 1301.102 (claim filing with insurers)

• We mailed your statement to the address you gave us.
• Under Texas law, a bill counts as sent on the date it is mailed to the address in our records.
• Your balance is still due.

Source: Texas Civil Practice and Remedies Code § 146.002(d) (when a bill counts as sent)

• Yes. As a self-pay patient, you agreed to pay for your visit when you received care.
• Texas's timely billing law limits only amounts insurance would have covered and amounts you would not otherwise have owed. Self-pay charges are amounts you owed at the time of your visit.
• Your balance is our posted self-pay rate for the services you received.

Source: Texas Civil Practice and Remedies Code § 146.003 (what a late bill limits)

• Medicare: Only the deductible and coinsurance that would have applied to your visit.
• Medicaid: Only the copay allowed by the Texas Medicaid program.

Sources: Medicare.gov: Medicare costs; 42 CFR § 447.15 (Medicaid payment accepted as payment in full)

• Every bill includes an itemized statement listing each service, the billing codes, and the amount due for each service.
• Press See visit bill details on your statement to see that breakdown straight away — there is nothing to request and nothing to wait for. It stays available for as long as we keep your billing records, and we can also post or email you a copy if you would rather have one.

Source: Texas Health and Safety Code Chapter 185 (itemized bill requirements)

• Call us at (469) 896-0398 to set up a payment plan.

Source: practice policy

• Any estimate given at the visit was based on the insurance coverage you reported at the time.
• The final amount is set by how your insurer processes the claim: it may apply a deductible, deny part of the claim, or decide a service is not covered.
• Your insurer's Explanation of Benefits shows what it decided for each service.

Sources: Texas Health and Safety Code Chapter 324 (health care cost estimates and disclosures); HealthCare.gov glossary: Explanation of Benefits

• Insurance rarely covers the full cost of a visit.
• You may owe a deductible, a copay, coinsurance, or the charge for a service your plan does not cover.
• These amounts are set by your plan and shown on your Explanation of Benefits.

Sources: HealthCare.gov glossary: deductible, copayment, coinsurance; Texas Insurance Code Chapter 1301 (how insurers process claims)

• We submit a claim to the insurance on file for every visit where we have coverage information.
• A claim can fail if the insurance information was incorrect, the coverage was inactive on the date of service, or a required referral or authorization was missing.
• If you give us correct or updated insurance now, we will submit the claim to that plan where possible.

Sources: Texas Insurance Code § 1301.102 (claim filing with insurers); Texas Civil Practice and Remedies Code § 146.002 (billing deadlines)

• A visit often includes several services: the exam, labs, imaging, or procedures.
• Your plan covers each service differently, so the total is the sum of your share of each one.
• Your itemized bill lists every service and what you owe for it.

Source: Texas Health and Safety Code Chapter 185 (itemized bill requirements)

• Different parts of your care may be billed separately: the urgent care facility, the provider who saw you, and any lab or radiology service.
• Each is its own claim to your insurance and its own bill.
• Your itemized statement shows which services are on which bill.

Sources: Texas Health and Safety Code Chapter 185 (itemized bill requirements); Texas Insurance Code Chapter 1301 (claims are filed per provider)

• Common reasons: the service is not covered by your plan, the provider was out of network, information was missing, or a prior authorization was required.
• Your insurer must tell you the reason on your Explanation of Benefits.
• You can appeal a denial with your insurer, and the Texas Department of Insurance takes complaints about how a claim was handled.

Sources: Texas Insurance Code Chapter 1301 (claim processing and appeals); Texas Department of Insurance: consumer complaints

• Yes, we offer payment plan options.
• Submit a billing inquiry form or call us at (469) 896-0398 and we will set one up with you.

Source: practice policy

• Complete the Billing Inquiry/Dispute Form and tell us what looks wrong.
• Our team reviews and verifies each charge, and works with your insurance where needed.
• You are entitled to an itemized bill listing every service and its charge.

Sources: Texas Health and Safety Code Chapter 185 (itemized bill requirements); Texas Department of Insurance: consumer complaints