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!

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!

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