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An ambulance company billed me after my emergency trip, and my HMO says the company is non-network. Do I owe that bill?

Health insuranceWho paysTexasChecked Nov 6, 2026

From K.Actuary, founded by Sangmin Kwon, ASA · sources checked 2026-11-06 · Source: Texas Insurance Code · Chapter 1271 · § 1271.159(a) «Non-Network Emergency Medical Services Provider» View original ↗

In short

  1. Texas limits what a ground ambulance can bill you [5].
  2. You owe only your share under the plan, and no more [5].
  3. The rule skips air ambulances, and it ends in 2027 [1] [6].

What this means

Start with what this rule covers. It uses the term emergency medical services provider, as defined in the Health and Safety Code [1]. But the term does not include an air ambulance [1]. So if you were flown, this is not your rule. And these sources do not say which rule covers that bill.

Next, what your HMO must pay. Did the political subdivision submit its rate to the department? Then the HMO pays that rate, for the place the service or the transport began [2]. If no rate was submitted, it pays the lesser of two amounts [2]. One is the provider's billed charge. The other is 325 percent of the current Medicare rate, with any extenders and modifiers that apply [2]. A submitted rate can also move each year. The political subdivision may adjust it by no more than the lesser of the Medicare Ambulance Inflation Factor, or 10 percent of the provider's rates from the previous calendar year [3]. The HMO must pay the provider directly. The deadline is the 30th day after a clean electronic claim, or the 45th day for one on paper [4].

Now your side of it. A non-network emergency medical services provider may not bill you more than your copayment, coinsurance and deductible [5]. The law adds that you do not have financial responsibility above that amount [5]. The bar also covers anyone claiming as an agent or assignee of the provider [5]. Your share is based on the amount the HMO first determined payable, or on the modified amount from its internal appeal [5]. So a bill for the leftover balance is the one to dispute in writing.

One limit to know before you lean on this. The section says in plain words that it expires September 1, 2027 [6]. Care given after that date may run on a different rule, so check the date of your transport. And note what this chapter does not promise here. The balance billing notice rule names the emergency care, facility-based and imaging sections, and it does not name this one [7]. So do not expect your explanation of benefits to state the cap for an ambulance claim. Ask the HMO in writing instead.

Your next step

Check the date of the transport first. Check whether it was a ground ambulance [1] [6]. Then put the bill next to your explanation of benefits. Find your copayment, coinsurance and deductible for that claim [5]. Write to the ambulance billing office and to the HMO on the same day. Say your responsibility is limited to those amounts. Ask for a corrected bill [5]. Ask the HMO two things in writing: the amount it determined payable, and the date it paid the provider [2] [4]. The sources give no deadline for your own letter. The dates they do give are the plan's: the 30th day after a clean electronic claim, or the 45th day on paper [4].

Check it yourself

Find the date and the type of transport on the bill [1]. Then find the amount your plan says you owe, and compare it with what the company is asking for [5]. Then ask your HMO which rate it used: a rate submitted by the city or county, or the lesser of the billed charge and 325 percent of Medicare [2]. What rule covers an air ambulance bill: "Don't know yet" here.

Where this comes from (7)

  1. [1] Texas Insurance Code · Chapter 1271 · § 1271.159(a) «Non-Network Emergency Medical Services Provider» · checked 2026-11-06

    In this section, "emergency medical services provider" has the meaning assigned by Section 773.003 , Health and Safety Code, except that the term does not include an air ambulance.

  2. [2] Texas Insurance Code · Chapter 1271 · § 1271.159(b) «Non-Network Emergency Medical Services Provider» · checked 2026-11-06

    a health maintenance organization shall pay for a covered health care service performed for, or a covered supply or covered transport related to that service provided to, an enrollee by a non-network emergency medical services provider at: (1) if the political subdivision has submitted the rate to the department under Section 38.006 , the rate set, controlled, or regulated by the political subdivision in which: (A) t…

  3. [3] Texas Insurance Code · Chapter 1271 · § 1271.159(c) «Non-Network Emergency Medical Services Provider» · checked 2026-11-06

    A political subdivision may annually adjust a rate submitted under Section 38.006 by not more than the lesser of: (1) the Medicare Ambulance Inflation Factor; or (2) 10 percent of the provider's previous calendar year rates.

  4. [4] Texas Insurance Code · Chapter 1271 · § 1271.159(d) «Non-Network Emergency Medical Services Provider» · checked 2026-11-06

    The health maintenance organization shall make a payment required by this section directly to the provider not later than, as applicable: (1) the 30th day after the date the health maintenance organization receives an electronic clean claim as defined by Section 843.336 for those services that includes all information necessary for the health maintenance organization to pay the claim; or (2) the 45th day after the da…

  5. [5] Texas Insurance Code · Chapter 1271 · § 1271.159(e) «Non-Network Emergency Medical Services Provider» · checked 2026-11-06

    A non-network emergency medical services provider or a person asserting a claim as an agent or assignee of the provider may not bill an enrollee receiving a health care service or supply or transport described by Subsection (b) in, and the enrollee does not have financial responsibility for, an amount greater than an applicable copayment, coinsurance, and deductible under the enrollee's health care plan that is based…

  6. [6] Texas Insurance Code · Chapter 1271 · § 1271.159(g) «Non-Network Emergency Medical Services Provider» · checked 2026-11-06

    This section expires September 1, 2027.

  7. [7] Texas Insurance Code · Chapter 1271 · § 1271.008(a) «Balance Billing Prohibition Notice» · checked 2026-11-06

    A health maintenance organization shall provide written notice in accordance with this section in an explanation of benefits provided to the enrollee and the physician or provider in connection with a health care service or supply provided by a non-network physician or provider. The notice must include: (1) a statement of the billing prohibition under Section 1271.155 , 1271.157 , or 1271.158 , as applicable; (2) the…

How we found this

We matched your question to 7 official sources, quoted the exact lines, and re-checked each quote against its source on 2026-11-06.

What we don’t know yet

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Every answer is checked against the official rule it quotes.

Information only — not legal advice. Your plan, insurer or agency decides.

This answer quotes the official sources listed above, with the date we checked them. Your own policy, notice and state rules control. We are not your lawyer or your insurer. We don’t file, argue or negotiate claims for you — you send any letter or form yourself.

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