Texas
Texas members should start with the carrier's credit process.
Texas Insurance Code § 1301.140 addresses qualifying direct payments under covered Texas PPO plans. The insurer determines its plan-specific actual-paid comparison through an accessible credit procedure.
Do not reuse another state's checklist.
- Confirm that the ID card and plan documents identify qualifying Texas-regulated PPO coverage issued or renewed on or after January 1, 2024.
- Confirm the service or supply is medically necessary and covered under the plan.
- A claim for the service is not submitted to your health plan.
- The direct payment must be below the insurer's average discounted rate paid to an equivalently licensed or authorized preferred provider under the plan.
- Ask the carrier for its accessible credit procedure and required documents before paying.
- Keep the written quote, itemized paid receipt, service code, provider identity, and no-claim confirmation.
- Treat the credit as plan accumulator activity, not a reimbursement.
Use the source this state or plan provides.
Texas does not publish a public per-plan actual-paid benchmark for this review. TDI's order explains why generic federal Transparency in Coverage negotiated rates do not establish the statutory average. Ask the carrier to confirm its comparison and required documentation.
Browse verified cash pricesGet the price and service codes in writing.
If you are not using insurance, ask for a written Good Faith Estimate. Federal rules generally require one when you request it or schedule care at least three business days in advance. This price document is separate from the state credit process. Read the CMS guidance →
Start with the published carrier instructions.
BCBSTX's purpose-built form tells members to check for the TDI symbol on the ID card and describes submission through the member portal's claim-attachment channel or by mail to P.O. Box 660044, Dallas.
Read the rule and current instructions.
Educational information only. The plan decides whether a payment qualifies, and state-specific scope, timing, and documentation control.