Short answer: Yes, by choice. Texas balance billing law applies to TDI-regulated plans, but Texas lets ERISA plans elect into the state’s independent dispute resolution process by filing TDI’s opt-in form; otherwise federal No Surprises Act rules govern a self-funded plan.
TDI explains that, for health plans it regulates, Texas law bans balance billing for certain services provided on or after January 1, 2020, and for emergency medical services and ground ambulance trips on or after January 1, 2024. Disputes go through TDI’s portal: mediation for out-of-network facilities and arbitration for out-of-network providers. Federal law applies to plans TDI does not regulate and to air ambulance services.
Texas House Bill 1592 allows ERISA plans to elect to participate in the Texas dispute resolution process, and TDI provides an opt-in form for plan sponsors. Before electing, the employer should confirm with its TPA and counsel which services the election covers and how it fits with the plan’s federal obligations and stop-loss policy.