We want our patients to rest assured when it comes to our billing process.
At Houston Medical ER, WE DO NOT BALANCE BILL OUR PATIENTS and WE HONOR IN-NETWORK BENEFITS.
(Please Note: At this time, we do not accept Medicaid or Medicaid Managed Care Plans)
You will receive an EOB (Explanation of Benefits) from your insurance that will include billing details of your visit and may have an amount listed that is not covered by your insurance plan or an amount that you are responsible for paying. We will work directly with your insurance company to make sure your claim is paid correctly according to your in-network benefits and Texas state law. It is typical of insurance companies to sometimes deny some of the charges – please rest assured, we will work with your insurance and WE DO NOT BALANCE BILL OUR PATIENTS. We are here to provide exceptional care to our patients, this includes the billing process.
We bill ALL commercial insurance plans including Aetna, Blue Cross Blue Shield, Cigna, Humana, United Healthcare, and also accept Medicare, Tricare, LOP’s (letter of protection from an attorney), self pay/cash pay, Care Credit and Health Savings Account.
We are out of network with most insurances, however, for cases deemed emergent, Texas State Law (Insurance Code Section 1301.155) requires your insurance company to pay for your emergency care at the in-network benefit level even if the emergency room is classified as out of network. The state of Texas empowers patients to use Prudent Lay Person Standard when determining what constitutes as an emergency. The “prudent layperson” standard is a generally accepted principle in the health care industry that applies to emergency medical care. This standard was created to protect consumers from high medical costs that arise from emergency situations, allowing them to be charged at in-network rates. Health plans are required to pay for emergency visits for medical situation in which a person believes his or her life is threatened. The final medical diagnosis should not influence whether the insurer pays for the emergency room visits, and insurers cannot legally apply the claim towards the out of network benefits.
Additionally, the Patient Protective and Affordable Care Act added numerous patient protections that requires health plans covering emergency services to provide such coverage at the in-network benefit level and without the need for prior authorization, regardless of the participating status of the provider.
IT IS IMPORTANT TO REMEMBER, THE EOB FROM YOUR INSURANCE IS NOT AN ACTUAL BILL FROM OUR FACILITY.
You will not receive a Balance Bill from us, we honor in-network benefits.
Please do not hesitate to contact us for any questions that you may have regarding billing or the EOB that you receive from your insurance.
Email inquiries: erbilling@medicalcareoftexas.com
Simplexmed Billing Company
Billing: (713) 457-4600
Bellmedex Billing Company
Billing: (800) 260-0232
We value our patients and want our patients to be completely satisfied with our services. We thank you for choosing Houston Medical ER for your healthcare needs.