Insurance Information

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.

Texas Senate Bill 425

Senate Bill 425, passed by the Texas Legislature during the 84th Regular Session, requires all FECs to post notice of the following:

  • This is a Freestanding Emergency Medical Care Facility
  • This facility charges rates comparable to a hospital Emergency Room and may charge a facility fee
  • This facility or physician providing medical care at this facility may not be a participating provider in your Health Benefit Plan provider network
  • A physician providing medical care at this facility may bill separately from the facility for the medical care provided to you

Texas House Bill 3276

  • The facility is not a participating provider in any health benefit plan provider network. However, by state law your health insurance company is required to process your ER visit at in network benefit levels.

Texas House Bill 2041

House Bill 2041, passed by the Texas Legislature during the 86th Regular Session, requires all FECs to post notice of the following:

  • This facility is a freestanding emergency medical care facility.
  • This facility charges rates comparable to a hospital emergency room and may charge a facility fee.
  • A facility or a physician providing medical care at the facility may be an out-of-network provider for the patient’s health benefit plan provider network.
  • A physician providing medical care at the facility may bill separately from the facility for the medical care provided to a patient.
  • The Emergency Center  is an in-network provider for Medishare and Christian Healthcare Ministries organizations.

San Antonio ER

11320 Alamo Ranch Pkwy San Antonio, TX 78253

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