How Does The Emergency Center Work With My Insurance?

The Emergency Center honors most private and commercial insurance plans. We are also proud to offer transparent pricing and discounts on payment at the time of service for patients without insurance. Our patients will never see a surprise bill, and if necessary, our billing team will work with you and your insurance to ensure you’re not stuck paying for emergency treatment that should be covered by your insurance plan.

What is the billing process at The Emergency Center?

Once you arrive at The Emergency Center, we ask you or a family member to check in, and complete and sign all relevant medical forms. This is a necessary first step so that we can ensure that all your insurance claims are processed timely and efficiently, avoiding delayed claims due to missing information.

At the time of service, we will accept any initial payment due, and then claims will be submitted to your insurance carrier to be applied towards your emergency department benefits. These amounts vary depending on your plan and any deductibles you may have already met. We use a software tool that is able to query major insurance companies to determine the status of your insurance at the time of service.

After your visit, our medical billing staff will send your insurance provider two claims, one from the ER physician examining you, and one from the facility.

Are you in-network with my insurance company?

The Emergency Center is not a participating provider in any health benefit plan provider network. However, by state law your fully funded health insurance plan is required to process your ER visit at in-network benefit levels. The physician providing medical care at the facility may not be a participating provider in your health benefit plan provider network. However, Texas law (House Bill 2183, Sec 1451.457) requires all emergencies to be processed utilizing in-network benefits.

Our billing team will work with you and on your behalf to make sure your insurer processes these claims correctly. In the case where your insurer does not process claims correctly, we will refile them on your behalf to make sure they are processed correctly.

How much will my visit cost?

The amount you may owe greatly depends on what your insurance company approves and the type of insurance plan you have. In an emergency setting, it is difficult for a provider to know this unique information before service begins. All health plans are different and may require a copay at the time of service. Depending on your insurance, you may also have co-insurance or a deductible. As is standard for most emergency rooms, your insurance provider will be billed a facility fee and a physician fee. Our prompt-pay cash discount price begins at $500 and may vary, depending on the treatments the physician chooses and how they decide to care for you, as well as your diagnosis and the services rendered. This ensures clear and straightforward costs tailored to your specific needs.

What forms of payment do you accept?

At The Emergency Center, we honor most private and commercial insurance plans, including Workers’ Compensation, cash, and most credit cards (Visa, MasterCard). For those patients experiencing financial hardships, we have multiple options to assist you in paying the bill, including installments. Please note that if a patient is experiencing a life-threatening emergency, we will not turn them away regardless of their ability to pay.

What is an Explanation of Benefits (EOB)?

In a few weeks after your visit, you will receive an Explanation of Benefits (EOB). This is not a bill. It is a summary of the services you received at The Emergency Center, including date and location, and the following information:

The amount your insurance plan covered.
The amount your insurance did not cover, if any.
The amount you should expect to pay.

If you have a question about your EOB, you should call Member Services at your insurance provider to go over your covered benefits.

Who do I call if I have a question about my bill?

The Emergency Center handles our medical billing to streamline the process, and to make it as uncomplicated as possible for you. If you ever have a question about your bill, please call 888-732-3317.

ACTION NEEDED – Medicare & Tricare Coverage Ends at Freestanding Emergency Centers

The Public Health Emergency (PHE) ended on May 11, 2023. With the expiration of the PHE, state licensed Freestanding Emergency Centers (FECs) are no longer able to participate in Medicare or Tricare unless the federal government passes legislation to make this benefit permanent. This is a significant change for Medicare and Tricare patients. The Emergency Center wants to permanently extend Medicare and Tricare benefits to include FECs. Our Medicare and Tricare beneficiaries deserve equal access to high-quality emergency care. The Emergency Care Improvement Act (HR 1694) is bipartisan legislation that will update the existing statute and allow beneficiaries to keep their coverage. When policy issues are being considered, legislators like to hear from their constituents. If you, a family member, or a friend have Medicare or Tricare, we urge you to contact your US House Representative and ask them to support the Emergency Care Improvement Act (HR 1694).

Whether you decide to call, email, or write your representative, here are a few things to keep top of mind:

Include your name, tell them you are a constituent in their district, and reference the legislation you support – Emergency Care Improvement Act (HR 1694).
State whether you, a family member, or a friend is a Medicare or Tricare recipient.
Share positive experiences related to The Emergency Center and explain why it is important for Medicare and Tricare beneficiaries to have equal access to emergency care.
Ask your representative to support legislation and make benefits permanent at FECs.

To find out who your US House representative is, use this link and type in your address.

Public Health Service Act 2799B-3 Protections Against Surprise Billing

The Public Health Service Act, amended in 2021 with an effective date of January 1, 2022 requires health care providers and facilities to post a notice of the following:

You are protected from balance billing for:

Emergency services – If you have an emergency medical condition and receive emergency services from an out-of-network provider or facility, the most the provider or facility may bill you is your plan’s in-network cost-sharing amount (such as copayments and coinsurance). You can’t be balance billed for emergency services. This includes services you may receive after you’re in stable condition, unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services.
Certain services at an in-network hospital or ambulatory surgical center – When you receive services from an in-network hospital or ambulatory surgical center, certain providers may be out-of-network. In these cases, the most those providers can bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers cannot balance bill you or ask you to give up protections not to be balance billed.

If you receive other services at these in-network facilities, out-of-network providers can’t balance bill you, unless you give written consent and give up your protections.

You’re never required to give up your protections from balance billing. You also aren’t required to get care out-of- network. You can choose a provider or facility in your plan’s network.

When balance billing isn’t allowed, you also have the following protections:

You are only responsible for paying your share of the costs (copayments, coinsurance, and deductibles) that you would pay if the provider or facility was in-network.
Your health plan will pay out-of-network providers and facilities directly.

Your health plan generally must:

Cover emergency services without requiring you to get approval for services in advance (prior authorization).
Cover emergency services by out-of-network providers.
Base what you owe the provider or facility (cost-sharing) on what it would pay an in-network provider or facility and show that amount in your explanation of benefits.
Count any amount you pay for emergency services or out-of-network services toward your deductible and out-of-pocket limit.

No Surprises Help Desk
1-800-985-3059
www.cms.gov/nosurprises/consumers
Texas Department of Insurance Help Line at 800-252-3439.

Per Senate Bill 425, which took effect September 1, 2015, House Bill 3276, which took effect September 1, 2017, and House Bill 2041, which took effect September 1, 2019, and relates to health care information provided by and notice of fees charge by Freestanding Emergency Medical Care facility, we are required to post a sign stating:

This is a freestanding emergency medical care facility.
This facility charges rates comparable to a hospital emergency room and may charge a facility fee provider network.
This facility or a physician providing medical care may be an out of network provider for the patient’s health benefit plan.
The physician providing medical care at the facility may bill separately from the facility for the medical care provided to a patient.
This facility is an out of network provider for all health benefit plans.

Per Senate Bill 2038

Freestanding ERs are required to publicly share testing charges or vaccinations for an infectious disease when a state of disaster has been declared.

COVID-19

The Emergency Center has a cash-pay rate option designed for uninsured patients. These patients often qualify for different levels of financial assistance depending on their financial situation. Out-of-pocket costs vary depending on the emergency services provided in conjunction with the visit. COVID-19 testing for patients who present with certain health risk factors and symptoms. Please be advised that testing is done on symptomatic patients in conjunction with an emergency room visit. Our in-house rapid antigen test is charged at $350.00. As a symptomatic patient, you will also be charged an ER visit. Total charges for an ER visit vary depending on the level of patient illness, severity of medical needs, and the resources required to render care.