If a Texas hospital or other licensed health care facility, or a collector working for it, is trying to collect a medical bill, you are entitled to an itemized bill first, and the provider cannot pursue collection until it has sent one.
Created Health and Safety Code chapter 185. A health care provider that bills a patient must send a written, itemized bill listing each service and supply in plain language, any billing codes and amounts billed to and paid by insurers, and the amount claimed from the patient, within 30 days after final third-party payment. A provider 'may not pursue debt collection' against the patient until it complies. Effective September 1, 2025, H.B. 216 requires providers using a patient portal to mail, email, or hand over the bill when the patient has no active portal account.
- Citation
- Tex. S.B. 490, 88th Leg., R.S. (2023), Acts 2023, ch. 271; amended by Tex. H.B. 216, 89th Leg., R.S. (2025), Acts 2025, ch. 717; Tex. Health & Safety Code ch. 185
- Court or agency
- Texas Legislature
- Date
- September 1, 2023
- Law
- Texas law
Summary
S.B. 490 was signed May 29, 2023, and took effect September 1, 2023. It applies to licensed health care facilities, including hospitals, but not federally qualified health centers. H.B. 216, effective September 1, 2025, clarified how itemized bills must be delivered, let patients choose the delivery method, and limited discipline when a mailed bill is returned undeliverable.
Background
Medical bills are one of the most common kinds of consumer debt, and they are often hard to check. A patient may receive a single balance-due statement long after a visit, with no breakdown of services, codes, or what insurance paid. By the time the account reaches a collector or a courtroom, the patient may have no way to tell whether the charges are right.
What changed
S.B. 490 (2023). Effective September 1, 2023, the bill added chapter 185 to the Health and Safety Code:
- Who is covered. A “health care provider” is a facility licensed, certified, or otherwise authorized to provide health care services or supplies in Texas, including a hospital. Federally qualified health centers are excluded.
- Itemized bill required. A provider that requests payment from a patient must send a written, itemized bill for each service and supply provided during the visit, no later than 30 days after it receives final payment from a third party such as an insurer.
- Contents. The bill must include a plain-language description of each service or supply, any billing codes submitted to a third party with the amounts billed and paid, and the amount the provider claims from the patient for each item.
- Collection bar. A provider “may not pursue debt collection against a patient” for a service or supply unless it has complied. “Debt collection” has the same meaning as in the Texas Debt Collection Act.
- Enforcement. The provider’s licensing authority must take disciplinary action for violations.
H.B. 216 (2025). Effective September 1, 2025, for itemized bills issued on or after that date:
- The bill must state the alleged “amount due” for each service and supply, rather than its “cost.”
- A provider may deliver the bill electronically, by mail or common carrier, or as a hard copy picked up at its office.
- A provider using a patient portal must check, if feasible, whether the patient has an active portal account, and if not, or if it cannot tell, must mail, email, or hand over the bill by the patient’s chosen method.
- Patients may request the itemized bill through their chosen method until the provider’s record-retention period ends.
- Discipline does not apply to a provider that in good faith mailed a hard copy that came back undeliverable or went to an outdated address.
Our take
Chapter 185 gives patients a concrete right that matters in collection: the right to see what they are being charged for before collection starts. The statute’s enforcement mechanism is licensing discipline, and it does not expressly create a private lawsuit. But because it says a provider may not pursue debt collection until it complies, a missing itemized bill is a fact worth raising when a provider, or someone collecting for it, demands payment or sues.
How courts will apply the collection bar to debt buyers and to suits over older medical accounts is not yet well developed. We would expect early disputes to focus on whether a bill was sent, when, and how.
What it means if you’re sued in Texas
If you are contacted or sued over a medical bill from a Texas hospital or other licensed facility, ask in writing for the itemized bill and keep a copy of your request. Compare it with your insurance explanation of benefits. If you never received an itemized bill, tell your lawyer, because it may affect the claim and your response to it. A free case review is available if you have been sued over a medical debt.
Takeaway
Before paying or settling a medical collection account, ask for the itemized bill. If the provider never sent one, that may affect whether collection, and any lawsuit based on it, was allowed.
Sources
Primary authority
- S.B. 490 enrolled bill text (Texas Legislature Online)
- S.B. 490 bill history (Texas Legislature Online)
- H.B. 216 enrolled bill text (Texas Legislature Online)
- H.B. 216 bill history (Texas Legislature Online)
- Texas Health and Safety Code chapter 185 (Texas Constitution and Statutes)
Secondary sources
- New Protections Against Medical Debt Start Today for Texans (Texas Association of Health Plans)
- Debt Collection: Medical Debt research guide (Texas State Law Library)
This summary and analysis are general information, not legal advice. Later decisions, amendments or agency actions may change the law; check the current status before relying on it.