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Understanding Your ER Bill

Understanding Your ER Bill

Emergency Room visits are often a disorienting, stressful, and nerve-racking affair, and to make matters worse, medical bills are notoriously difficult to understand, so your stress doesn’t end the minute you walk out of the ER.  Understanding your ER Bill is not something that is common knowledge.

Nevertheless, it’s in your financial best interest to know exactly what you are paying for and the ways you can lower your out-of-pocket expenses when you receive a medical bill.

At Altus Emergency Centers we believe in billing transparency, and helping our communities safeguard their hard-earned money. We know firsthand that there is no way to thoroughly plan for a medical emergency, which is why we are committed to help our patients receive all the benefits of their health plans and save as much money as possible.  For this reason, we bring you a simple guide to understanding your ER Bill that we hope will help settle your nerves and save you money.

What Are Facility and Physician Fees?

After receiving treatment in one of our centers, we will mail two separate claims to your insurance company:

  • Facility Fee Claim
  • Physician Fee Claim

 

Facility Fee

All Emergency Rooms (hospital and freestanding) charge a facility fee. Facility fee charges depend on the level of emergency care provided to our patients which ranges from basic emergency care to immediate life-threatening conditions.

The facility fee does not include medications, supplies, diagnostic imaging such as CT scans and X-rays, or laboratory tests.

 

Physician Fee

In the past, emergency physicians would bill for their services separately and their fees vary depending on the level of care provided.

Starting back on June 2019, at Altus Emergency we directly control physician billing to ensure you superior service.

All patients are treated exclusively by our in-house local doctors, and this allows us to control the entire billing process.  The best news is that you will never receive a surprise medical bill from us. Please keep in mind that physician services will still be billed separately for transparency purposes.

On the other hand, the physician fees of Radiologists (X-Rays) and Pathologist (Lab) are included in the facility fee.

Know Where to Go in Case of an Emergency.

Documents You Should Expect from Your Insurance Company

Once we file the insurance claims on your behalf, your insurance provider will review them and determine how much is covered by your plan and how much you need to pay out of pocket.

 

EOB

An Explanation of Benefits (EOB) is the statement sent to you by your health insurance company explaining which services your insurance covers, the amount paid by your plan and how much you need to pay out-of-pocket.

The balance due considers your deductible, coinsurance, and other non-covered benefits.

You should receive your EOB before you get an actual bill from us. When you get your EOB, please review it carefully, make sure you are not being billed twice for the same service or service you did not receive.

Double-check that the insurance company is paying for everything your plan includes, if you need help doing this you can contact our Patient Advocate, they can help you understand your coverage and negotiate with your insurance company.

 

Informative Letters

Some insurance companies will send you a letter with additional information regarding your coverage. They will appear to sound “nice” while they explain that they are not covering your costs and even claim that they will try to help you lower your out-of-pocket costs.

Some of these letters might make it look like independent ER’s (also called freestanding ERs) like Altus Emergency Centers are more expensive than hospital-based ER’s.

Check out an example of a real letter from Cigma that an Altus Emergency patient received after being treated.

However, thanks to a recent law which forces medical providers to list their standard costs for procedures we now know this is not true.

In fact, we can prove that Altus Emergency is not more expensive than a hospital ER.  In some cases, we are actually less expensive than a hospital ER and we can PROVE IT.

The following chart reveals the prices of some of the most common medical emergency services. Listed are their total price at a Freestanding Emergency Center and what the same service costs at a hospital.

Cost Differences for Common Medical Emergency Conditions

SCENARIO 1: CHEST PAIN

Total Cost

ALTUS ER

$4,328.63

Hospital

$5,512.00

Your visit to Altus Emergency just saved you: $1,183.37

SCENARIO 2: ABDOMINAL PAIN

Total Cost

ALTUS ER

$9,754.68

Hospital

$11,143.87

Your visit to Altus Emergency just saved you:Altus Savings of $1,389.19

SCENARIO 3: BACK/FLANK PAIN

Total Cost

ALTUS ER

$6,755.48

Hospital

$9,383.00

Your visit to Altus Emergency just saved you: $2,627.52

SCENARIO 4: HEAD INJURY

Total Cost

ALTUS ER

$8,010.63

Hospital

$8,595.00

Your visit to Altus Emergency just saved you: $584.37

Get Personalized Help in Understanding Your ER Bill

 

Additionally, our Patient Advocate will always try to negotiate better rates and find ways to maximize your health insurance benefits so we can lower your out-of-pocket expenses.

At Altus Emergency Centers our priority will always be our patient’s wellbeing. We guarantee you will receive the best emergency care regardless of your ability to pay.

If you have questions about your ER visit, medical problems, worsening symptoms, or you wish to speak to your nurse or doctor, please contact us.

Get Peace of Mind, Call Patient Advocate

If you have any questions regarding your billing or insurance please contact our Patient Advocate Department. 

Lumberton & Waxahachie: Call us (469) 383-7361 between 8:00 am and 5:00 pm and ask for the Patient Advocate.

Baytown & Lake Jackson: Call us (979) 529-2000 between 12:00 pm and 7:00 pm and ask for the Patient Advocate.

Altus Emergency Centers Texas

is Here for You 24/7

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!

Explanation of Benefits. What You Need to Know

Understanding the Explanation of Benefits

If you’ve been to the doctor or the ER recently and used your health insurance to help pay for the treatment, then you can expect to receive an Explanation of Benefits in the mail soon. But, what is this document, what should you do when you get it, and why is it important?

What do you need to know

What is an Explanation of Benefits?

Simply put, an Explanation of Benefits (EOB), is a notification to let you know when your health care benefits claim has been processed by your insurance company.

It’s important to understand that an explanation of benefits is not a health care bill. The EOB will detail the expenses that were submitted by the healthcare provider (doctor, hospital, ER, urgent care center, etc.) and lets you know how the claim was processed.

What do you need to know

What Information Does Your EOB Include?

There is no standard format for an explanation of benefits, however, most include three main sections:

  • Total of Claim or Claims: Your EOB might contain more than one claim. The notification will highlight all the financial information about each claim, including:
    • Total Amount Billed by the Healthcare Provider
    • Total Benefits Approved by the Insurance Company Based on Your Plan Coverage
    • Any Amount Owed to the Healthcare Provider
  • Service Detail: Here you will find a list of all the services you or your dependent received from the healthcare provider. This section should include:
    • The Name of the Doctor or Facility You Attended
    • Date of Services
    • Date of Charges – Both Billed and Allowed

Some Insurance Companies Display any Additional Savings that Your Plan Provides Such as Provider Discounts and Other Deductions

Summary: This Will Show You a Clear Picture of Your Deductible, Copays, And Health Spending Accounts if Applicable.

Additional information regarding amounts not covered, and out-of-pocket expenses might also be included.

What do you need to know

What Should You Do When You Receive an EOB?

Your explanation of benefits is an essential record of claims for any medical services and benefit coverage, and you should hold on to it for at least 18 months, preferably two years in case any questions or disputes arise from about your claim or your bill.

What do you need to know

What Do You Need to Check on Your Explanation of Benefits?

When you first receive your EOB, you should carefully check the information it contains, and pay close attention to the following:

  • Make sure your personal information is correct if not, it could be a simple mistake, but in the worst-case scenario it could be someone trying to use your identity
  • Ensure you are not being billed for a service you did not receive. If your EOB contains more than one claim, make sure you are not being charged twice for the same service.
  • Make sure which doctor or health care provider submitted the claim and cross check it with your records to make sure there are no mistakes.
What do you need to know

What Happens if the Insurance Company Doesn’t Pay the Whole Amount?

If your healthcare plan doesn’t cover the whole amount of the services you received, then the health care provider will send you a bill for the amount owed.

You do not have to pay anything until you receive the bill, and never pay more than the amount the explanation of benefits says you owe. If you are billed more than what the EOB says, you should contact your insurance company immediately, so they can investigate this matter.

If your insurance company didn’t pay anything, find out why, it could be that you have not met your annual deductible, but, it could also be a mistake on their part, if that is the case you need to submit an appeal.

 

Altus Emergency Centers has focused its efforts on helping people better understand their insurance plans and how our billing works. If you have any questions regarding your billing, please don’t hesitate to call our Patient Advocate Department, it will be our pleasure to assist you.

What do you need to know

Know Where to Go In the Event of an Emergency

If you are ever in need of quality emergency care, you will not have to wait in line at Altus Emergency Centers. All of our ERs are fully equipped and open 24/7.

Altus Emergency Centers Texas is Here for You 24/7

altus emergency 24 hr ER Texas

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, 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.

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