With the passing of Texas Senate Bill 1264, arbitration is used for billing disputes between out-of-network health care providers (not facilities) and health plans. The goal of arbitration is to decide which amount is closest to the reasonable amount of the provided health care service or supply:
- The amount the health plan paid or, if applicable, the amount the health plan modified during an appeal or informal settlement period. or
- The amount the provider charged or, if applicable, the amount the provider modified during an appeal or informal settlement period.
Arbitration must take place within 51 days from the date arbitration is requested through the Independent Dispute Resolution portal. To book an arbitration, please submit your case through the TDI portal or inquire by calling our office. The arbitrator will evaluate the final billed charges and final reimbursement amount offered based on the 10 factors listed in Texas Insurance Code Section 1467.083.
For TDI disputes, the process will follow the Texas Insurance Code Section 1467.083. Arbitration will be conducted online. No travel is needed. For more information about the arbitration of medical bills, please visit Texas Department of Insurance. Note, disputes are not required to go through TDI.
Amy Laine is pre-approved with Blue Cross Blue Shield of Texas and Superior Health.