Tex. Ins. Code § 566.051

Limitations on Billing; Notice

Effective Sep 1, 2025Added by Acts 2025, 89th Leg., R.S., Ch. 1003 (S.B. 1330)
  1. (a) A nonparticipating supplier may not charge an enrollee more than 115 percent of the Medicare-approved amount for durable medical equipment, orthotic devices or supplies, or prosthetic devices or supplies covered under Medicare for which the supplier has not accepted written assignment unless:

    1. (1) before the enrollee is billed, the enrollee agrees in writing to pay the additional amount; and
    2. (2) before receiving the durable medical equipment, orthotic device or supply, or prosthetic device or supply, the enrollee:

      1. (A) enters into a rental payment plan; or
      2. (B) pays the additional amount in full.
  2. (b) A written agreement between a nonparticipating supplier and enrollee under this section must provide notice to the enrollee that:

    1. (1) Medicare will reimburse 80 percent of the Medicare-approved amount for durable medical equipment, orthotic devices or supplies, or prosthetic devices or supplies covered under Medicare; and
    2. (2) a Medicare supplement benefit plan issuer is not required to reimburse the nonparticipating supplier or enrollee for the amount by which the charge exceeds 115 percent of the Medicare-approved amount.

Added by Acts 2025, 89th Leg., R.S., Ch. 1003 (S.B. 1330), Sec. 1, eff. September 1, 2025.

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