TX Department of Insurance Notice

  • You have the right to an adequate network of Participating Providers (also known as “network providers”).
    • If you believe that the network is inadequate, you may file a complaint with the Texas Department of Insurance.
    • If you obtain out-of-network services because no Participating Provider was reasonably available, you may be entitled to have the
      claim paid at the in-network rate and your out-of-pocket expenses counted toward your in-network deductible and out-of-pocket
      maximum.
  • You have the right to obtain advance estimates:
    • of the amounts that the providers may bill for projected services, from your out-of-network provider; and
    • of the amounts that the insurer may pay for the projected services, from the insurer.
  • You may obtain a current directory of Participating Providers at the following website: http://www.assuranthealth.com or by calling 1-800-328-4316 for assistance in finding available preferred providers. If the directory is materially inaccurate, you may be entitled to have an out-of-network claim paid at the in-network level of benefits.
    • If you are treated by a provider or hospital that is not a Participating Provider, you may be billed for anything not paid by Us.
    • If the amount you owe to an out-of-network hospital-based radiologist, anesthesiologist, pathologist, emergency department physician, or neonatologist is greater than $1,000 (not including your copayment, coinsurance, and deductible responsibilities) for services received in a network hospital, you may be entitled to have the parties participate in a teleconference, and, if the result is not to your satisfaction, in a mandatory mediation at no cost to you. You can learn more about mediation at the Texas Department of Insurance website: http://www.tdi.texas.gov/consumer/cpmmediation.html.