What if I Have Questions About my Emergency Room Bills?

What if I Have Questions About my Emergency Room Bills?
After a visit to the ER, you will no doubt get a bill when you leave. However, you may not always be happy with the kind of bill you get. Just like any other service, it is possible that some mistakes will occur during the preparation of your bill. Thus, you should never be afraid to speak up. We at Bellaire ER will explain the ER billing process. We hope that it will help clear up some of the issues you may have. We will also give you a few tips on what to do in case you are unhappy with a bill.
How the billing process works at the ER
Each time you visit the ER, you are always given long forms, which you have to fill in with your health insurance details. The information will then be filed with a copy of the health insurance card. Most people usually leave the process at that; they have no idea what goes on after. In this article, we will try to demystify the billing process for you
What goes on after you provide the information?
After you fill in the information, a health insurance claim is filed with your insurer. A health insurance claim is a bill your insurer gets for medical services, which you received at the ER. The insurance company then agrees to pay this claim base on the services you got. In most cases, there is co-pay, which is a payment you will make from your own pocket. However, the insurer will usually cover the largest chunk of the bill.
Everyone is covered for the ER
If you have insurance, it always comes with insurance cover, no matter how basic your plan might be. In fact, if you live in Texas, the insurer has to cover you, no matter which ER you visit. When you are experiencing a medical emergency, the decision as to whether to visit the ER is up to you. Your insurer is legally required to pay for any out of network costs for your ER visit.
When you are done filing the admission paperwork at the ER, you will be requested to pay the co-pay, which your policy establishes during your visit. You can then ask for the billing options from the billing clerk for the ER you visit. At some emergency rooms, they honor in-network billing even when they are not part of the insurer’s network. They know that these details can help to cut down the total claim made by the insurer.
The explanation of benefits is not bills
As soon as you leave the ER, the billing process kicks off. You will soon after get an explanation of benefits or EOB in your mail. This document will list the services, which you received when you were in the ER, and their individual costs.
However, you have to keep in mind that the EOB is not the bill. The ER uses it to generate a claim for your insurer. The insurance company will then determine what amount, they are obliged to pay. Any extra amount will be billed to you, which means you will have to pay out of pocket.
Why you may get separate bills from the ER
The emergency rooms that are attached to the hospital usually rely on the ER to treat ER patients. When you visit an ER, your insurance is going to be billed by the physician and facility. Besides that, each department that will treat you will bill you separately. Most departments are usually separate entities legally. It is only that they operate in the same building. Thus, they have to bill you separately.
However, if you visit a separate ER, it helps to eliminate the issues of multiple claims for the ER visit. Most of the emergency rooms that are standalone will bill your insurer for any services as part of your facility bill. The physician will still make a separate claim, which will lead to only two claims for the visit. By combining the billing, these standalone ERs help to speed up the processing of a claim.
How to deal with surprise bills
After you visit the ER for what seemed like a minor issue to you, you might receive a bill of thousands of dollars, which you are supposed to pay. However, you do not have to pay it and suffer in silence.
The first step you have to take is to check the bill. It is estimated that over 80 percent of all ER bills come with some errors. This can be worse if you visit an ER, which is usually very busy. The other step you can take is to make a complaint. In some cases, your insurer will determine that some of the services you received are not covered. However, if you make a complaint, a huge chunk of these complaints usually succeed.

How Oversight of Insurance Companies can prevent Surprise Medical Bills

How Oversight of Insurance Companies can prevent Surprise Medical Bills

Surprise medical bills are one of the biggest problems that both patients and the physicians agree on. It is frustrating when you get an unexpected medical bill that will cost you up to thousands of dollars, yet you have health insurance. The surprise medical bills are usually a product of the doings of insurance companies. It is part of the business strategy insurance companies providing health insurance use to make them look more valuable.

A patient will purchase a health insurance package with the hope that it will help them pay for their medical care. But for insurance companies, it is a business. So what they do is that they create a sufficiently and irresistibly attractive plan, enroll policyholders then work around to ensure that the biggest chunk of the cash they receive stays with them instead of going to health care for the patients. Additionally, they will advertise and recommend specific physicians and medical facilities just to save more money. The end result is that the insurance companies end up benefiting while the patients are left having to bear the costs of their medical bills.

To get the burden of such bills off the back of patients, Bellaire ER advocates for the idea of oversight of insurance companies. This will help regulate the policies and actions of health insurance service providers to the benefit the patients. Most of the states, including Texas, have laws that require insurers to cater for the costs of non-contracted emergency health care and at the normal rates. The problem comes when you look at the guidelines. The guidelines that govern this law are not uniform, providing room to the insurance companies to determine their own rates. That is why you will find a good number of insurance companies having a payments percentage that is way lower than what the law stipulates. The result is the burden of surprise medical bills being created as the patients end up not receiving the full benefits they ought to receive from their health insurance provider.

Freestanding emergency rooms have been a popular target for health insurance companies. The model of freestanding emergency rooms is quite an innovative one and provides better access to emergency care for patients more effectively and efficiently. But they have been accused of misleading patients and lacking transparency; as per the narrative that insurance companies have. They use this as their basis for processing freestanding emergency center claims. As per the law in Texas, FECs are recognized as essential and are supposed to be processed at the same level as in-network benefit or the normal customary level. However, insurance providers use their “lack of transparency” excuse and the lack of clear guidelines in the law to charge out-of-network rates for freestanding emergency center claims. They end up denying the patient’s coverage access yet they are paying their insurance rates. The result is higher patient responsibility in the form of the surprise bills.

In a move deemed as a step towards the right direction for Texas, the Texas Association of Freestanding Emergency Centers passed a resolution that calls for the Texas Department of Insurance and the Texas Legislative arm to increase and improve data collection with regards to health insurance payment. With this data, it will be much easier for both the patients and the insurance providers to be certain as to what constitutes the customary reimbursement for Texas emergency room procedures. This is part of the efforts that are being made to improve the oversight and the transparency of health insurance companies and the health insurance industry in general.

Data from the Texas Department of Insurance clearly shows that there has been systematic attempts by a good number of insurance companies to slash the payments slated for freestanding emergency centers and have the costs channeled to their patients instead. In fact, some of these insurance companies go as far as keeping the freestanding emergency centers in the out-of-network category intentionally just to ensure that they pay the least amount possible in healthcare claims. This is a chronic practice that can only be stopped with increased oversight of these health insurance service providers to ensure that they are fair to their customers.

This behavior is becoming increasingly rampant and more people are not realizing the benefits of having a health insurance cover. To turn the tables in favor of the patients and against the “greedy” profit approach that insurance companies are employing, the legislative arm of the Texas Government should make it a priority to establish the appropriate laws and clear guidelines to regulate health insurance companies. They should come up with clear standards that are easily enforceable for reimbursements rates that can hold health plans accountable. The main goal is ensuring that all citizens get easy, affordable and reliable access to quality health care. A clear oversight of insurance companies will go a long way in ensuring the realization of this goal.

What is The Texas Association of Freestanding Emergency Centers (TAFEC)?

What is The Texas Association of Freestanding Emergency Centers (TAFEC)?

Freestanding Emergency Centers are a relatively new concept in Texas, having been established in 2009. This form of healthcare differs from other healthcare providers due the type and quality of healthcare offered. There are many freestanding emergency centers spread all over Texas. To maintain high quality standards and present a unified voice, the freestanding emergency centers formed the Texas Association of Freestanding Emergency Centers (TAFEC). Bellaire ER explores the formation and functions of TAFEC.

Formation

The freestanding emergency care industry was established in 2009 under House Bill 1357. However, there were few freestanding ERs in Texas that operated individually before the bill was passed. Each of these ERs set their own regulations about operating times and the quality of care.
After the recognition of the freestanding ERs by law, there was a need to standardize their practices. It is due to this need that TAFEC was formed. The association became the first statewide representation for FECs in the United States.

Aim

TAFEC looks to provide a unified voice from the freestanding emergency centers. This way, the industry can present its views clearly and have a central point of representation. This unification helps the industry pay an important role during the creation of laws and regulations affecting the freestanding emergency centers.

TAFEC is also involved in creating awareness on freestanding emergency centers all over Texas. Through their awareness mandate, TAFEC aims to inform residents about the benefits of FECs and how to use them.

TAFEC also helps to maintain high quality standards for all its members. This includes high quality service to patients in minimum wait times.

Advocacy

TAFEC has been involved in many advocacy roles to create fair regulation for the FEC industry.
Health insurance transparency is one of the items under TAFEC’s legislative agenda. TAFEC is pushing for legislation that will require insurance companies to be transparent about how they calculate the rates paid to out-of-network healthcare providers.

The problem of surprise medical costs has plagued consumers who visit FECs. People are often presented with huge medical bills especially when they visit out-of-network FECs. This is because some insurance companies only cover a small portion of the bill and thus the patient is left to cater for the rest out-of-pocket.

With a transparent calculation mechanism, the insurers will have to be consistent in their payments to healthcare providers and the law can institute penalties for any insurance company that underpays.

Keeping in its role to provide fair regulation in the industry, TAFEC is looking to eliminate surprise medical bills through legislation. They hope to create a law that standardizes the reimbursement rates from the insurance providers. This way, patients will not be presented with surprise medical bills as they’ll already know how much their insurance covers.

Apart from the transparency of insurance companies, TAFEC also aims to promote the transparency of FECs. FECs in Texas were plagued with the problem of people confusing them with urgent care centers. This led to the passage of the Senate Bill 425 that mandated FECs to provide clear signage and information on the difference in cost and quality of care between them and urgent care centers.

The bill requires the FECs to post notices that inform patients that the facility is a freestanding emergency center and that billing is similar to a hospital based emergency center. The notices also inform the patients that their medical insurer might not cover their costs and that the physician attending to them might bill separately from the hospital.

These notices have to be placed in areas where they are clearly visible such as the entrances, treatment rooms, payment locations, and on the FECs website.

The bill helped to reduce complaints by patients who were met with surprise bills to the Texas Department of State Health Services.

In keeping with the need for transparency, TAFEC also has a section on its website that informs patients on which healthcare facility can serve them best. The section primarily aims to distinguish between urgent care and emergency centers. Illnesses and injuries such as flu symptoms, sprains, cuts, and allergies are best treated at an urgent care. Emergency rooms should be accessed for true emergencies such as heart attacks, stroke, chest pain, and severe burns.

TAFEC also has a lot of materials on other subjects such as FEC billing and Texas medical statutes. All this information is meant to help patients make the right decision when visiting a healthcare center. It also helps them access quality healthcare in times of an emergency since they know that that the insurers are supposed to pay for the emergency services at in-network rates.

Membership

TAFEC has 30 members who run 220 FECs across Texas. The FECs are located in more than 100 communities all over Texas. All the facilities operated by each member have to join if the parent company decides to join the association. These facilities also have to pay separate dues.