Billing And Insurance

billing-and-insurance-image Securely Pay your Bill online:

Insurance Plans

At Victoria ER, we accept all private insurance plans including Aetna, United Healthcare, Humana, Blue Cross/Blue Shield and CIGNA. We can honor your in network benefits even if we are not part of your Provider’s network. We also accept cash, checks and major credit cards including Visa, MasterCard and Discover Card. Our rates are reasonable if you choose to self-pay or pay out of pocket. Rates can be quoted to you by our front desk staff.

In-Network vs. Out of Network

According to Texas guidelines, all insurance carriers are required to pay in-network benefits for any member seeking emergency care. The law requires your insurance provider to cover your emergency care whether or not it is in-network or out of network. When considering what defines an “emergency”, the state of Texas empowers you to use a prudent layperson standard. Texas state law requires insurance carriers to reimburse patients for their emergency room visits. If your insurance provider refuses payments for your ER visit, you can file a grievance with the TX Dept of Insurance. To learn more about the TX Dept of Insurance, please visit http://www.tdi.state.tx.us.

Making sense of your Bill

Medical billing can be a cumbersome process. At Victoria ER, we aim to be open and transparent with our billing process. We want to make sure that you understand bills that you might receive from us. These bills may be different from those received from hospitals and doctor offices. Victoria ER is a licensed freestanding ER facility that functions in the same way as a hospital-based ER. Under Texas guidelines, all insurance providers are obligated to pay in-network benefits for any member in need of emergency care. The law even states that you must be reimbursed by your insurance provider for your emergency room care. Texas law mandates that your insurance provider pay for your emergency room treatment whether you are in or out of network. The state of Texas gives you the ability to use a prudent layperson standard when determining what dictates an emergency.

Your Insurance Benefits

If you are insured, you will receive an explanation of benefits (EOB) from your insurance provider in the mail. This will explain our charges. This is not a bill. Please note that there may be additional charges related to your visit depending on your insurance plan. For most insurance providers, we are considered out of network. However, we honor all in-network deductibles and benefits. We will contact your insurance provider and notify them that we are honoring your in-network benefits. By reviewing your EOB from your insurance company, you can make the process simpler by knowing your benefits. Reviewing your insurance policy will allow you to determine if you have deductibles, co-insurance or anything else that you may be responsible for. This will allow you to make an educated decision when seeking medical treatment.

How We Bill

Your emergency room co-pay will be collected at the time of your ER visit. We will bill your insurance provider for your emergency room benefits. There will be two claims mailed to your insurance provider. One for the facility and the other for the physician. There will not be separate fees for Radiology, Pathology or Cardiology “over-reads” or interpretations as is seen with hospital-based ERs. These charges are included within the facility portion of the bill. In order to treat emergency conditions effectively, ERs must diligently prepare. This preparation is much higher than what is traditionally seen at other medical facilities. The facility fee that is charged by the ER helps to offset the ongoing expenses related to maintaining this level of preparation. These costs are incurred in an attempt to provide you with the best in emergency care. The facility fee is calculated based on a point system. This system is based on procedures performed, patient acuity level, level of liability potential and the physician/patient interaction. If you have any questions regarding your billing and insurance, contact our billing office at 832-807-2927. We will work closely with you to resolve any issues and look forward to serving you in the near future.

Leave a Reply

Your email address will not be published. Required fields are marked *

*
*