Senate Bill 425
• Victoria ER is an emergency room.• Victoria ER charges rates comparable to a hospital emergency department, including a facility fee.
• The physician may bill separately from the facility.
• Victoria ER and facility-based physicians may not be a participating provider in an individual’s health plan network.
For more information about Senate Bill 425, click here.
In-Network Emergency Room Benefits
Guidelines set by the state of Texas mandate that insurance carriers are required to pay in-network benefits to members receiving emergency medical treatment. It is Texas law that your insurance provider pay for your emergency room treatment, even if the provider typically classifies the facility as “out-of-network.” You are empowered by Texas state law to use the prudent layperson standard when deciding if you are having a medical emergency.Your insurance provider is required to reimburse you for emergency treatment. If your insurance company is refusing to reimburse you for your emergency room visit, you may file an official complaint with the Texas Department of Insurance. For additional info about the Texas Department of Insurance go to http://www.tdi.state.tx.us.
Understanding your Victoria ER Bill and Insurance Benefits
Medical billing can seem complicated and overwhelming, but we strive to make the process as simple and transparent as possible for our patients.Patients with health insurance will get a statement called an explanation of benefits (EOB) in the mail from the insurance company that will explain the charges. It’s important to remember that your EOB is not itself bill; it is simply a statement explaining what was billed, how much was covered, and how much may be left over. Depending on your insurance plan, there may be remaining charges associated with the visit that will be your responsibility.
Victoria ER honors “in-network” deductibles and benefits for all private insurance plans. We will inform your insurance provider that our facility honors in-network benefits.
To understand the process and your benefits better, make sure to read the EOB you get from your insurance provider. This will help you to understand your policy coverage and other details like deductibles and co-insurance, as well as whether or not any other charges will be your responsibility.
Victoria ER’s Billing Policy
During your visit to Victoria ER we will collect your emergency room co-pay, which will be due in full at that time. Your insurance provider will be billed for the remaining charges.Please note that emergency rooms must maintain a significant degree of preparedness at all times in order to effectively treat all patients’ emergency medical needs. Maintaining this high level of preparedness is more expensive than at other, non-emergency medical facilities. Emergency rooms will charge a facility fee to each patient in order to offset those costs and ensure that every patient has access to the life-saving care that they need. Our facility fee is calculated according to a point system based on multiple different factors including procedures performed, complexity of the physician/patient interaction, potential liability, and patient acuity.
If you have questions about your Victoria ER bill or our billing and insurance policies in general please contact Tyvan Billing at 713.357.2535.