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No Surprises Act · Texas
Out-of-network claims in Texas — that payment is an opening offer
Dispute pathway: Federal IDR + state pathway
Out-of-network surgical and hospital-based claims in Texas are routinely paid below the billed charge or denied outright. Under the No Surprises Act that payment is an opening offer, and dispute resolution exists to contest it. Sydra checks what qualifies, assembles the submission, holds every deadline, and can file it for you.
How disputes route in Texas
Federal IDR + state pathway
Texas resolves out-of-network disputes through TDI-administered binding arbitration for providers and mediation for facilities (SB 1264, 2019; SB 2544, 2025; Texas Insurance Code ch. 1467). Balance billing is banned for emergency care, out-of-network services at an in-network facility, and lab or imaging tied to in-network care.
State-regulated plans, including the Texas ERS and TRS plans, follow Texas's process, as do self-funded ERISA plans that have opted in. Other self-funded ERISA plans follow the federal IDR process. Confirm routing by plan type before filing.
What's specific to Texas
- Two tracks: out-of-network providers use binding arbitration and facilities use mediation. Facility mediation must be requested within 180 calendar days of the provider's receipt of the initial payment.
- The provider arbitration window also runs from receipt of the initial payment, not the date it was issued; we confirm it against each claim rather than quoting a general figure.
- The arbitrator picks whichever side's amount is closer to a reasonable amount, weighing statutory factors that include the 80th percentile of billed charges and the 50th percentile of allowed amounts.
Deadlines once a Texas dispute is running
Request TDI mediation — facility track
180 calendar days
from the provider's receipt of the initial payment
Set by SB 2544 (2025) for this track. Out-of-network providers use a separate arbitration track, and we confirm that window against each claim rather than quoting a general figure.
Tex. Ins. Code §1467.054(a), as amended by SB 2544 (2025)
Informal settlement period
30 calendar days
from the request being filed
Extendable by mutual agreement.
Tex. Ins. Code ch. 1467
Texas runs two tracks: facility mediation, with the statutory window above, and provider arbitration, whose window we confirm against the claim before filing. We also confirm which track a claim belongs to.
Claims that go to federal IDR follow a defined pathway between a payer's underpayment and a binding payment determination — an open negotiation window, an eligibility determination, a batching decision, then a decision by a certified IDR entity. Claims under Texas's own law follow the state rules described above instead. Each step has its own deadline, and missing one can cost the claim. Providers win roughly 88% of federal IDR determinations they contest. Sydra is a capped, predictable fee — less than half of what most contingency firms charge. We file it, you keep the recovery.
Browse by specialty
Commonly disputed procedures in Texas
Return to the Federal IDR hub.
No outcome is guaranteed. Results vary by claim, payer, specialty, and documentation. State routing depends on plan type; confirm against the CMS applicability chart before filing. This is general information, not legal or financial advice.
Medically & clinically reviewed by Dr. John M. Abrahams, MD
Board-certified neurosurgeon and founder of Sydra · Last reviewed September 2026 · About the author
Sources
Figures reflect the published federal record across all disputes, not a prediction about any individual claim. This is general information, not legal or financial advice.