The recently enacted Texas Senate Bill (SB) 2544 imposes mandatory mediation filing deadlines for out-of-network (OON) facility providers. Under Insurance Code Chapter 1467, OON facility providers (including ambulatory surgical centers (ASCs), hospitals, free-standing emergency rooms, and birthing centers) must complete the Texas Department of Insurance’s (TDI) mediation process before bringing a civil action regarding billing disputes with health benefit plans regulated by TDI, as well as self-insured ERISA health benefit plans that have opted in to the mediation process.
The mandatory mediation process does not apply to claims for services provided to beneficiaries of Medicare, Medicaid, or self-insured ERISA health benefit plans that have not opted in to the mediation process.
Mediation Request Deadlines
Previously, the Texas Insurance Code language allowed mediation to be requested without a specified timeframe.
- After June 20th – For Services Provided On or After June 20, 2025: Effective June 20, 2025, OON facility providers must request mandatory mediation no later than the 180th day after receiving an initial payment for a health care or medical service or supply.
It is likely if mediation is not requested by the 180th day, then billing disputes will not be eligible for mediation, and the OON facility provider will be barred from bringing a civil action to resolve the dispute (although this is not specifically stated in SB 2455).
- Before June 20th – For Services Provided Before June 20, 2025: According to TDI, OON facility providers have 120 days from June 20, 2025, to request mediation for any out-of-network services provided before that date. Therefore, mediation must be requested for billing disputes related to health care or medical services or supplies provided prior to June 20, 2025, by October 18, 2025. However, since October 18, 2025, falls on a Saturday, a TDI representative has communicated via email that all requests for mediation must be made by October 20, 2025, which is the next business day. Please note that TDI has not publicly announced this October 20, 2025, deadline.
After 120 days from June 20th (October 20, 2025), disputes are no longer eligible for mediation, and the OON facility provider will be barred from bringing a civil action to resolve the dispute.
The opinions expressed are those of the authors and do not necessarily reflect the views of the firm, its clients, or any of its or their respective affiliates. This article is for informational purposes only and does not constitute legal advice. For more information, please contact Jeffrey Frost at Jackson Walker, LLP via phone at (512) 236-2269 or email at jfrost@jw.com.
Meet Jeff
Meet JeffJeffrey H. Frost draws on more than 20 years of experience as in-house counsel to advise clients on healthcare regulatory matters, hospital operations, and medical staff issues. As the former Deputy General Counsel at an integrated health network in Northern California, Jeff’s experience includes advising medical staff, medical groups, and hospitals on a full range of credentialing, privileging, peer review, and quality assurance topics, as well as assisting hospital administration with governmental investigations, fraud and abuse claims, agency complaints, and medical staff hearings.