It is important that you understand your insurance benefits. Our friendly team can help you if you have questions about our fees and billing. We are an emergency care facility, and thus bill as such. If you have a co-pay, it will be the amount required for an emergency room visit, and not the co-payment required for an urgent care facility. Your out-of-pocket expenses, such as deductible or co-insurance for example, will depend on your insurance company and plan.
We will process your insurance for your emergency visit. Due to federal regulations, Medicaid and Medicare do not currently provide reimbursement to free-standing emergency rooms. We will not refuse patient treatment in the event of a life-threatening situation, regardless of the ability to pay.
We are affiliated with BSA, therefore we are considered in-network with BSA insurance.
According to Texas and federal law, insurance carriers are required to pay in-network benefits for any member seeking emergency medical treatment. Whether the emergency room you choose is in-network or out of network for you, the law requires that your insurance carrier pay for your emergency care (US Dept. Health and Human Services). If your insurance company refuses payment for your emergency room visit, you can file a grievance with the Texas Department of Insurance.
The specified percentage (stated in your health insurance contract) of the claim amount that is allowed but not paid by the insurance company after you’ve paid your deductible.
For example: If a visit is $100 and your coinsurance is 10% (and you’ve already met your deductible), you would pay 10% of $100 which is $10.
The amount you would pay for a covered service, usually after your deductible has been met. This is usually a fixed amount set by your insurance company that varies depending on the service (ie. medications, xray, ER visits, urgent care visits, office visits, etc.)
The specified amount (stated in your insurance contract) that the patient pays for covered heathcare services, usually annually, before insurance begins to pay. For example, a $1000 deductible would mean the patient pays for the first $1000 of covered services.
Patients are sometimes unsure if their annual deductible has been met. Insurance policies run on an annual cycle, not necessarily tied to the calendar year. If your insurance billing cycle has completed, your deductible resets which can cause your out-of-pocket expenses to be higher than expected. It is important to note 1) what is your deductible? and 2) when does your insurance cycle reset?
In-network healthcare providers are contracted with the insurance company to provide services at a pre-negotiated or pre-set rate. Usually care received at a in-network provider will cost the patient less than going to an out of network provider.
The covered services provided to patients by a provider who is not contracted in a particular payer’s network. Often times out-of-network costs to the patient will be higher than in-network costs as the amount of billed charges covered by the insurance plan will vary. Different insurance plans and companies provide different rates of coverage for out of network services.
The approval must be obtained from the insurance company prior to receiving a medical service or procedure. Usually, this is not applicable to emergency visits.
We are a free standing Emergency Room with all of the medical equipment and lab services a hospital emergency room provides. The difference is personal care with relatively no wait time. Because we are an ER, we Bill Emergency Room rates.
Occasionally, we find that certain “self-insured” policies do not cover ER on Soncy’s services. Because of this, it may be reflected in a higher bill at the time that services are provided. It is important to know whether the specific provisions in your insurance plan that allow for Free-standing Emergency Rooms.
We believe that every patient coming through our doors has a condition that worries them. And by Texas law, any emergency visit must be assessed an “in-network” rate, however, if your insurance company classifies your final diagnosis to not be an emergency, the fees could possibly reflect “out-of-network” rates. When you receive your statement, carefully review it and check to see if you received in-network rates. If not, a call to your insurance company can help rectify the charges. Please note that if you receive an explanation of benefits (EOB), that is not a bill.
For more medical billing terms, you may visit the Texas Department of Insurance’s Glossary of Common Insurance Terms or refer to your insurance policy.
As always, we are available for any questions or concerns you have. Please feel free to call us at (806) 340-0608.