What to Do When You Can’t Afford Your ER Bill

What to Do When You Can’t Afford Your ER Bill

Regardless of how organized you are with your money, nobody is ever fully financially prepared to deal with a medical emergency.

In recent years, most American’s have developed a real fear of having to visit a hospital or emergency room.  According to a study done by Harvard University, medical expenses were responsible for 62% of total bankruptcies in the US with 72% of those who filed bankruptcy due to medical costs had some form of insurance. If you are insured, you should be covered, right?  The fact is insurance companies with do everything possible to avoid paying claims.

With the growing trend of insurance companies looking for unlawful ways to deny emergency room visit claims, what can you do to avoid financial distress?

1. Don’t Panic!

We know having to deal with unexpected medical bills is a source of dread and anxiety, but, the worst thing you can do once you receive a bill from the emergency room is to panic.

Allowing anxiety to take over can cause more problems for you down the road. Keeping a clear, calm attitude will let you to review your bill and figure out what your next step should be.

PROTECT YOUR RIGHTS!

2. Review the Bill for Errors

Calmly check the bill to make sure you are being billed for the treatment you received; there have been cases where a patient was double billed for the same service by mistake, or even being charged for a procedure they did not receive.

  • If your bill does not include a detailed description of the charges, call the provider and ask them to send it to you.
  • It’s important to know that healthcare providers use codes known as Current Procedural Terminology (CPT) to report medical, surgical, and diagnostic procedures and services, you can search for them on the internet to decode their meaning.
  • Make a list of any items you have questions about.
  • Call the billing department at Altus Emergency Centers to make an appointment to review your bill as soon as possible. If there is one, they will be corrected, and a new statement will be sent to you.

3. Contact Your Insurance Company

If you have health insurance and feel you should not have to pay the amount owed, you need to contact your insurance agent as quickly as possible to ask why they are not honoring the terms of your insurance plan.

  • If your insurance company says the CPT code on the insurance claim is not covered by your plan, ask them which codes are covered by the program. This is important because in some cases our billing department might be able to change the code for a similar one that is covered by your insurance plan.
  • When your claim was denied because your insurer did not consider your procedure to be medically necessary, our doctors would be happy to write a letter explaining why the course of treatment was required.
  • If the insurance company is refusing to pay for your emergency room visit because the ER was not in network, let them know you are aware of your rights as a patient, and that the law requires insurance companies to pay for emergency medical treatment regardless of whether the facility is in network or not.

4. If All Else Fails, File an Appeal

There will be times when your insurance company will try to use fear tactics to get you to back down and pay out of pocket for services that should clearly be covered in your plan.

If you have tried to reason with them, and it has not worked, contact the Patient Advocate team at Altus Emergency Centers and bring them up to speed with everything you have done up to that point. They will try to speak to your insurance provider, and if they are unable to resolve the issue, they will gladly file an appeal on your behalf.

If your formal appeal is denied, you can refile another, and if the insurance company declines that one too, then you can request your claim to be reviewed by an independent third party who will give a final resolution.

5. Negotiate

If all your appeals are denied, or you are uninsured or are unable to pay the out of pocket amount, there are options available for you.

At Altus Emergency Centers we offer financial assistance for patients who cannot afford to pay their bills at once.

The first thing we will recommend is that you request a payment plan rather than use your credit card to pay for the amount due. Our Patient Advocate personnel can design a payment plan that fits your budget.

 

While it’s always a good idea to save for a rainy day, a medical emergency can happen at any time and to anyone. At Altus Emergency Centers we firmly believe that no patient should ever hesitate or fear to come in for treatment for fear of receiving a bill they cannot afford. For this reason, our Patient Advocate staff will work hard to ensure you receive the full benefits of your health insurance plan.

Contact our Patient Advocate department if you feel your insurance company is not honoring the terms of your healthcare plan, we can help you understand your benefits and your rights as a patient. We can also assist with the lengthy and often confusing health insurance appeal process.

Remember Altus Emergency Centers and the law are on your side!

MY EMERGENCY, MY CHOICE!

Altus Emergency Centers Texas is Here for You 24/7

Altus ER. We-Have-Dedicated-Specialists

Altus Emergency Centers are all open 24/7/365, with no lines. Our facilities are well-equipped to diagnose and treat everything from major to minor adult and pediatric emergencies.  We are honored to be a part of our beautiful Texas communities and work hard each day to help see them grow and prosper!

24 Hour ER Services – Best in Texas

Looking for the best quality 24 hour ER services?

We offer the best freestanding 24 hour ER services in Texas. We have top of the line medical technology and highly experienced ER healthcare experts prepped and ready to come to your aid in Baytown, Lake Jackson, Lumberton, and Waxahachie.

Each ER team is highly efficient in treating chest and abdominal pains, pediatric emergencies, flu symptoms, sports injuries, bone breaks, and fractures, as well as all other major and minor injuries. All services are available 24/7, including weekends and holidays with little to no wait times.  After You Receive Quality ER Care, our Patient Advocate will help ensure Hassle-Free Billing.

Our Promise is to Always Help Find the Best Solutions in Benefit of our Patients from the time you walk-in without having to wait in line and when you are personally assisted with the billing process.  We are here to help you get well and stay well!

Prudent Layperson Standard, GET THE FACTS, KNOW YOUR RIGHTS!

Prudent Layperson Standard,

GET THE FACTS, KNOW YOUR RIGHTS!

If you have ever had to deal with a health insurance company, you know first hand that they have a reputation for using scare tactics to prevent users from fully benefiting from their health insurance plans.

The latest attack on the public’s wellbeing was initiated by Anthem BlueShield BlueCross, the largest health insurer in the country, who unilaterally has decided to deny coverage to emergency room patients based on the final diagnosis rather than evaluating the symptoms which prompted the visit in the first place.

This decision is unlawful as it goes against the Prudent Layperson Standard, which Congress extended to apply to individual and group market health insurance plans in 2010.

What is the Prudent Layperson Standard?

Before 1997, insurance companies could deny emergency department claims based on the final diagnosis instead of symptoms. This meant that anyone who visited the ER complaining of chest pains which was later determined not to be a heart attack, or any other life-threatening condition would have to be responsible for 100% of the cost of treatment.

This forced patients to contact their insurance company during a moment of crisis to ask for permission to visit the ER, a policy which clearly placed the health and wellbeing of the individual in jeopardy.

As a result of these dangerous and unfair requirements, Congress enacted the Prudent Layperson Standard in 1997 which stated:

The term “emergency medical condition” means a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that a prudent layperson, who possesses an average knowledge of health and medicine, could reasonably expect the absence of immediate medical attention to result in:

 

  • Placing the health of the individual (or, in the case of a pregnant woman, the health of the woman or her unborn child) in serious jeopardy,
  • Serious impairment to bodily functions, or
  • Severe dysfunction of any bodily organ or part
  • Serious disfigurement

Originally the Prudent Layperson Standard only applied to Federal Health Plans such as Medicare and Medicaid, however, as of 2010 thanks to the Affordable Care Act, the standard was extended to include all private healthcare plans.

The great state of Texas adopted this Prudent Layperson definition in 1997 through Senate Bills 385. Section 1301.155.

PROTECT YOUR RIGHTS!

How Can Insurance Companies Deny Claims if It’s Against the Law?

This is the questions we are all trying to answer, in fact in March of 2018 two U.S. Senators sent a letter to the secretaries of U.S. Department of Health and Human Services and the U.S. Department of Labor requesting that they look into potential Prudent Layperson Standard violations by health insurance companies.

The truth of the matter is that the Prudent Layperson Standard is a federal law, and any attempt by a health insurance company to deny coverage based on final diagnosis rather than the symptoms present at the time of arrival to an Emergency Room is unlawful.

What Can Patients Do to Protect Their Rights?

Any person who experiences acute severe symptoms needs to receive an emergency medical evaluation to determine the cause and to receive proper treatment.

Nobody who is not medically trained should be forced to determine if their symptoms are severe enough to go to the ER. The Prudent Layperson Standard was explicitly drafted to ensure patients receive the emergency medical services they need when they need it.

This means that anyone who believes they are experiencing a medical emergency should visit the nearest Altus Emergency Center for evaluation without any fear; our Patient Advocate will help you every step of the way and file a claim on your behalf.

If your claim should be denied, our Patient Advocate will file an appeal, and even request an external review by a third party if necessary.

You can rest assured that at Altus Emergency Centers we will fight to protect your rights!

MY EMERGENCY, MY CHOICE!

Altus Emergency Centers Texas is Here for You 24/7

Altus ER. We-Have-Dedicated-Specialists

Altus Emergency Centers are all open 24/7/365, with no lines. Our facilities are well-equipped to diagnose and treat everything from major to minor adult and pediatric emergencies.  We are honored to be a part of our beautiful Texas communities and work hard each day to help see them grow and prosper!

24 Hour ER Services – Best in Texas

Looking for the best quality 24 hour ER services?

We offer the best freestanding 24 hour ER services in Texas. We have top of the line medical technology and highly experienced ER healthcare experts prepped and ready to come to your aid in Baytown, Lake Jackson, Lumberton, and Waxahachie.

Each ER team is highly efficient in treating chest and abdominal pains, pediatric emergencies, flu symptoms, sports injuries, bone breaks, and fractures, as well as all other major and minor injuries. All services are available 24/7, including weekends and holidays with little to no wait times.  After You Receive Quality ER Care, our Patient Advocate will help ensure Hassle-Free Billing.

Our Promise is to Always Help Find the Best Solutions in Benefit of our Patients from the time you walk-in without having to wait in line and when you are personally assisted with the billing process.  We are here to help you get well and stay well!

SIGN THIS PETITION

TO ADD YOUR VOICE TO THE FIGHT AGAINST INSURANCE COMPANY EMERGENCY DENIALS.

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