What is a Surprise Medical Bill – We Got Rid of Them!

What is a Surprise Medical Bill?

Don’t Worry, We Got Rid of Them!

Few things are as unpleasant as having an accident that lands you in the ER. The one exception might be getting hit with an unexpected or surpise medical bill.

But why are you getting a surprise medical bill if you are insured?

Here is What Happens

When you visit an emergency room, regardless of whether it is in-network or not; you may be treated by physicians and other medical staff that may not be part of your insurance plan network.

When this happens, the insurance companies won’t cover the full amount, and you will receive a bill saying you owe the out-of-network provider money. These bills are called balance bills and are commonly referred to as surprise medical bills.

What is Balance Billing?

If the emergency room, and doctor that treated you are both in-network, then you will only need to pay for what is negotiated in your plan, usually this involves:

  • Copay fees
  • Deductibles
  • Co-insurance amounts

However, if the ER or the doctor is an out-of-network provider, you will receive a balance bill, which is the difference between what the doctor charged and what the insurance company paid.

Know Where to Go in Case of an Emergency.

What Can You Do?

During a medical emergency crisis, nobody has the time to check if a doctor is part of their insurance network.

But fear of not being able to pay for healthcare should never stop you from getting it.

Therefore, in case of an emergency, come to the nearest Altus Emergency Centers immediately. Let us save your life first, and we will resolve the financial part later.

When you receive a balance bill or in other words a surprise medical bill, here are the steps you should follow:

 

 

1. Always Request an Itemized Invoice

 

Texas law requires providers to present an itemized bill upon request. Some providers will send it automatically, but if you don’t get it, ask for it!

Reviewing your bill could help reduce the amount owed in two ways:

  • You can verify there are no duplicate charges
  • You can confirm you are only being charged for procedures, tests, and treatments you received.

Billing departments handle vast amounts of data every day. So, it’s possible for some unintended errors to occur. Carefully reviewing your balance bill is the best way to avoid overcharges.

 

 

2. Call Patient Advocate

 

If you received a balance bill from us, the first thing you should do is contact our Patient Advocate.

Our staff is available to answer any questions and address any concerns you have regarding your bill.

Additionally, our Patient Advocate may be able to negotiate rates with insurance companies to help lower your bill.

We can even offer financial aid or customize a payment plan that works for you.

Surprise Medical Bills May Soon be a Thing of the Past in Texas

Earlier this month, in a unanimous vote, the Texas House approved Senate Bill 1264.

When signed into law, SB 1264 will prohibit out-of-network providers from invoicing patients for their services directly.

Instead, the law would allow providers and insurers to negotiate with one another to secure payment. The legislation also creates state regulatory authority over that arbitration process.

What this means for you as a Consumer

This is excellent news for you as a consumer!

This Senate Bill will give us more leeway to push insurance companies to pay fair prices for the services provided without having to burden you.

Altus Emergency Centers Goes the Extra Mile

 

In case you haven’t heard the news,  at Altus Emergency we directly control physician billing to ensure you superior service.

Since June 2019, all patients are treated exclusively by our in-house local doctors.

Additionally, this means we control the entire billing process so you will never receive a surprise medical bill from us. Physician services will still be billed separately for transparency purposes.

 

What Does that Mean to You?

 

  • We hire local doctors. Therefore, you can expect to see a friendly and familiar face every time you visit us.
  • Better Quality Control & Greater Accountability
  • More Qualified Physicians. We hold our physicians to a higher standard than that required by the State Board.  Visit our Altus Physicians Group page for more information.
  • We control billing in house. No Balance or Surprise Billing
  • Transparency. Physician bills will remain separate to maintain transparency. You will be able to see and review the breakdown of the costs.
  • Local Billing. Bills will come from our Regional office in Southeast Texas

 

At Altus Emergency Centers, we are always looking out for your health and your finances. Contact our Patient Advocate if you have any questions or concerns with your bill.

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!

PROTECT YOUR RIGHTS to ER CARE!

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!

Join the Movement Against Insurance Company Denials

JOIN THE CAUSE,

TOGETHER, WE CAN PUT A STOP TO INSURANCE DENIALS

Anyone who has had to deal with an insurance company knows firsthand of all of the obstacles that they put up.  These excuses, scare tactics, and misinformation which are a common practice in spite of the fact that they go against Texas Law.

Don’t let Insurance Carriers Put Profit Over Patients. No Texan should ever be discouraged from seeking emergency care at the nearest ER. Do not make the mistake of denying yourself access to the best possible emergency care if in the absence of medical attention your health will be seriously jeopardized.

We are on your side.  Texas Freestanding Emergency Centers Save Lives and we will continue to do so. Join the My Emergency My Choice Moment by Signing the Petition below. Tell your legislators to vote for your emergency care to be covered.

SIGN THIS PETITION

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

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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!

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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Tips to Choosing Your Healthcare Plan Wisely

What to Ask When Choosing Your Healthcare Plan

The 2019 open enrollment period opened on November 1st and ends on December 15th, 2018, this means that many of us are actively shopping for the health care plan that bests suits our needs and budget.

To get the most out of our medical insurance plans, we must understand how the plans work, and what they cover. State and Federal insurance laws obligate insurers to include certain benefits and provide certain protections; however, insurers offer different plans from which you can choose, some will provide more coverage and protection than others, but this usually means the extra coverage comes at a price.

When you are shopping for healthcare coverage, insurance companies will provide a summary of each of their plans, this information will help you choose the right plan for you and your family. But, keep in mind the insurers won’t provide all the details of the plan until you have enrolled in the plan.

healthcare-plan

What is a Healthcare Policy?

For all intent and purposes, a health care policy is a legal contract between you and the health insurance company or health maintenance organization (HMO). When you enroll in a program, the insurance company or HMO will provide a copy of the contract, this will give detailed information about what your rights and responsibilities are under the plan.

For more information on the types of plans offered in Texas, please visit the Texas Department of Insurance (TDI)

healthcare insurance

Can I Cancel the Plan If I am Not Satisfied with the Coverage?

Yes, when you receive your copy of the policy detailing all the benefits, it is essential you read it carefully, especially if you have any special health needs. This will be the first time you are seeing the details of the coverage you will receive, and it’s important for you to know that if you are not satisfied with the policy, you have 10 days to return it and get a refund of your premium.

What is the Best Way to Compare Plans?

When you are shopping for medical insurance, ask the provider for their summary of benefits and coverage. This is the best way for you to compare healthcare plans as this document uses a standardized format making it easier to compare one item to another.

This summary outlines the basic coverage and cost of the plan you are interested in and will include the following:

  • Benefits and Exclusions
  • Links to Your Preferred Provider Directory and Drug Formulary
  • Deductible Amount
  • Coinsurance and Copayment Amounts
  • Out-of-Pocket limits
  • Referral Requirements
Medical-plan-patient

Always Ask About Emergency Medical Coverage

State and Federal laws obligate insurance companies to include Emergency Medical coverage in their policies. However, as we mentioned before, how much is covered can change from one plan to the next. As of August 6th, 2018, the Texas Department of Insurance (TDI) approved a controversial new program which grants the largest Health Insurance company in Texas to deny payments for some ER visits. Therefore, it is crucial to ask how your plan will process emergency medical treatment and ER visits before you enroll.

Can You Appeal a Deny of Payment on ER Treatments?

Absolutely, every consumer has the right to appeal the insurance company’s decision to not pay for treatment received in the ER.

According to the TDI, they received assurances from the insurance company that patients will have the right to have their doctor debate the treatment plan provided with the insurer doctor before a denial of payment was issued, and patients will be able to appeal the denial with an independent review organization.

Altus Emergency Center’s Patient Advocate department is available to patients review their health insurance claims and to aid in the event of an appeal of payment denial. Our priority is and always been the wellbeing of our patients, and our doctors follow care protocols to ensure the best medical care is provided.

Healthcare-claim

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 get you well fast 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.

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.

HEALTH NEWS, EVENTS & MORE.

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Altus Emergency Centers

We had such a great time learning about S.T.E.M. (Science, Technology, Engineering, & Mathematics) at Lumberton ISD. Great work guys, your future is bright moving forward.

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Altus Emergency Centers

We forgot that yesterday was Support Your Local Chamber of Commerce Day and how could we forget the 👸 Queen of the Chamber, Sandra Womack!

👏 Thank you for all you do for the Lumberton TX Chamber of Commerce!

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