# Tex. Insurance Code § 1275.003: BALANCE BILLING PROHIBITION NOTICE

> Texas · Statutes · In force

URL: https://www.frixlaw.com/law-library/statutes/STATE_TX_Cin_C1275_S1275.003

## Section

- **Citation:** Tex. Insurance Code § 1275.003
- **Heading:** BALANCE BILLING PROHIBITION NOTICE
- **Jurisdiction:** Texas
- **Kind:** Statutes
- **Status:** In force
- **Text as of:** August 14, 2026
- **Source:** Compiled text
- **Location:** TX Code / Code in / Chapter 1275 / Section 1275.003

## Text

(a) The administrator of a health benefit plan to which this chapter applies shall provide written notice in accordance with this section in an explanation of benefits provided to the enrollee and the physician or health care provider in connection with a health care or medical service or supply provided by an out-of-network provider. The notice must include:

(1) a statement of the billing prohibition under Section 1275.051, 1275.052, or 1275.053, as applicable;

(2) the total amount the physician or provider may bill the enrollee under the enrollee's health benefit plan and an itemization of copayments, coinsurance, deductibles, and other amounts included in that total; and

(3) for an explanation of benefits provided to the physician or provider, information required by commissioner rule advising the physician or provider of the availability of mediation or arbitration, as applicable, under Chapter 1467.

(b) The administrator shall provide the explanation of benefits with the notice required by this section to a physician or health care provider not later than the date the administrator makes a payment under Section 1275.051, 1275.052, or 1275.053, as applicable.

## Nearby sections

- [Tex. Insurance Code § 1275.001 § 1275.001. DEFINITIONS.](https://www.frixlaw.com/law-library/statutes/STATE_TX_Cin_C1275_S1275.001.md)
- [Tex. Insurance Code § 1275.002 § 1275.002. APPLICABILITY OF CHAPTER.](https://www.frixlaw.com/law-library/statutes/STATE_TX_Cin_C1275_S1275.002.md)
- [Tex. Insurance Code § 1275.003 § 1275.003. BALANCE BILLING PROHIBITION NOTICE.](https://www.frixlaw.com/law-library/statutes/STATE_TX_Cin_C1275_S1275.003.md)
- [Tex. Insurance Code § 1275.004 § 1275.004. OUT-OF-NETWORK CLAIM DISPUTE RESOLUTION.](https://www.frixlaw.com/law-library/statutes/STATE_TX_Cin_C1275_S1275.004.md)
- [Tex. Insurance Code § 1275.051 § 1275.051. EMERGENCY CARE PAYMENTS.](https://www.frixlaw.com/law-library/statutes/STATE_TX_Cin_C1275_S1275.051.md)
- [Tex. Insurance Code § 1275.052 § 1275.052. OUT-OF-NETWORK FACILITY-BASED PROVIDER PAYMENTS.](https://www.frixlaw.com/law-library/statutes/STATE_TX_Cin_C1275_S1275.052.md)
- [Tex. Insurance Code § 1275.053 § 1275.053. OUT-OF-NETWORK DIAGNOSTIC IMAGING PROVIDER OR LABORATORY SERVICE PROVIDER PAYMENTS.](https://www.frixlaw.com/law-library/statutes/STATE_TX_Cin_C1275_S1275.053.md)
- [Tex. Insurance Code § 1275.054 § 1275.054. OUT-OF-NETWORK EMERGENCY MEDICAL SERVICES PROVIDER PAYMENTS.](https://www.frixlaw.com/law-library/statutes/STATE_TX_Cin_C1275_S1275.054.md)

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Source: Frix Law Library, https://www.frixlaw.com/law-library/statutes/STATE_TX_Cin_C1275_S1275.003. Check the current official text before relying on it. Not legal advice.