If your hospital, ambulatory surgery center, freestanding emergency room, or birthing center bills commercial health plans for out-of-network services in Texas, a new law has fundamentally changed how long you have to dispute an underpayment.
Texas Senate Bill 2544, which took effect June 20, 2025, closes a significant gap in the state's out-of-network dispute resolution framework. It imposes a mandatory 180-day deadline for facility providers to request mediation under Texas Insurance Code Chapter 1467. Miss that window, and your dispute is no longer eligible for mediation – and you lose the right to bring a civil action to recover what you are owed.
What SB 2544 Changes – and Why It Matters
Texas Insurance Code Chapter 1467 has required out-of-network facility providers to complete the Texas Department of Insurance's (TDI) mandatory mediation process before filing a civil lawsuit over a billing dispute with a TDI-regulated health benefit plan. Until now, there was no hard deadline to request mediation. That loophole is now gone.
SB 2544 amends the Texas Insurance Code to establish a clear filing window: out-of-network facility providers must request mandatory mediation no later than 180 days after receiving an initial payment for the disputed healthcare service or supply.
This change brings facility providers in line with the existing 90-day mandatory arbitration lookback period that already applied to out-of-network non-facility providers – physicians and physician groups – under the same Chapter 1467 framework. The legislature's intent was to create a consistent, time-limited dispute resolution system and prevent the practice of submitting large batches of stale claims years after services were rendered.
Who SB 2544 Affects
The 180-day mediation deadline applies to out-of-network facility providers disputing payments from:
- TDI-regulated commercial health benefit plans (HMOs and PPOs)
- Self-insured ERISA health benefit plans that have opted in to the Chapter 1467 mediation process
The deadline does not apply to claims for services provided to Medicare or Medicaid beneficiaries, or to self-insured ERISA plans that have not opted in to mediation.
What This Means for Your Texas Healthcare Facility
If your facility regularly bills commercial plans for out-of-network services – and receives initial payments that do not reflect what is “usual, customary, and reasonable” for your services in your market – you now have a firm, non-negotiable deadline to act on each disputed claim.
Once the 180-day window closes, a disputed claim is no longer eligible for mediation under Chapter 1467 – and without mediation, a facility provider cannot bring a civil action to recover the disputed amount.
Stay on top of those deadlines to protect your right to dispute underpaid claims.
How Hendershot Cowart P.C. Can Help
Our healthcare attorneys advise Texas facility providers on the full spectrum of out-of-network reimbursement disputes – from evaluating whether an initial payment triggers the 180-day clock, to preparing and submitting the mediation request, to representing your interests through the TDI mediation process and any subsequent litigation.
If you have received out-of-network payments from commercial plans since June 20, 2025, and have not evaluated those claims for mediation eligibility, now is the time. Deadlines under SB 2544 do not pause while you assess your options.
Call (713) 783-3110 or contact us online to speak with a Hendershot Cowart P.C. healthcare attorney about your out-of-network billing disputes.