Your insurance will receive two claims, one from the ER physician examining you, and one from the facility. If you have an ultrasound, X-ray or CT scan performed, an additional claim will be filed from the radiologist who read your image.
It is important that you provide the hospital registration personnel with the most accurate insurance information. This will ensure that the proper billing procedures will take place and that you have a clear understanding of the billing processes and your financial responsibility.
Federal and State legislation has provided protections for members of health plans under the ‘prudent layperson’ standard. This means that if a prudent layperson would have felt that your presenting problems represented an emergency and that delaying care to find a contracted physician or to get ‘prior authorization’ from your health plan would have worsened the condition, the plan is obligated to cover those services at in-network rates.
Sometimes, insurance companies will attempt to claim that the facility is not in network and attempt to make you responsible form a greater portion of the bill. This is illegal in the State of Texas. If this happens, do not panic. Most likely, our billing company has already addressed this and has filed an appeal. However, should you receive any communications from your insurance like this, please let us know so we can resolve the issue. It is rare that we do not resolve the issue without requiring you to be involved.
We understand the hassle that many insurance companies make patients go through. We will do everything possible to help you with your financial responsibility. We have seen insurance companies outright deny coverage for premium paying patients because the physician group is not a ‘contracted provider’. This is unethical at best and illegal in many cases. There are steps you can take to encourage your insurance company to pay for the coverage you need.