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.

[contact-form-7 id=”15784″]

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.

[contact-form-7 id=”15784″]

Top Seven Holiday Medical Emergencies

Top 7 Holiday Medical Emergencies & When to Head for the ER

We all know how crazy the Holiday Season can be, with relatives coming in from out of town, finding that perfect gift, getting your home decorated, and preparing that unforgettable holiday meal.

With the all the commotion and parties to attend, the risk of suffering an accident, increase during this time of year.  Then there is the question, “Should I visit the ER for this emergency?”  Holiday medical emergencies are a serious concern, especially during Christmas and New Years Eve.

There are about 250 injuries a day during the holiday season. These are the top 7 reasons why people visit the ER during the holidays. Get the facts and signs of alert that you need to visit your nearest emergency center.  If you get quality ER treatment fast, you may be back in time to enjoy your holidays with your friends and family.

Holiday Decorating Injuries

Our first of our holiday medical emergencies believe it or not involves holiday decorating. The U.S. Consumer Product Safety Commission (CPSC) estimates that Emergency Rooms across the country attend some 15,000 injuries involving holiday decorating during November and December each year, and the number of injuries is on the rise.

Out of those estimated 15,000 cases:

  • 34% involve falls
  • 11% are from cuts and lacerations
  • 10% are due to back strains

Head for the ER if:

  • You fall from a ladder, stool, or roof. You have a broken bone or an internal injury
  • If you have cut yourself and bone or tendons are visible
  • If you lost consciousness after a fall, you might have a concussion
  • If you have severe pain or mobility issues

Alcohol and Drug Abuse

It is not a surprise that alcohol and drug abuse is on our holiday medical emergencies list. Emergency room visits for injuries related to alcohol usage continue to rise according to a study by researchers at the National Institutes of Health. The investigation revealed that Emergency Room visits for acute or chronic alcohol-related treatment rose by 61 percent between 2006 and 2014.

 

Out of all the drug and alcohol-related injuries treated by Emergency Rooms each year:

  • 17.1% occur on New Year’s Day
  • 10.1 occur on Christmas Day

 

Severe alcohol poisoning could lead to death if you see anyone displaying the following symptoms bring them into the ER immediately:

  • Metal Confusion
  • Vomiting
  • Slurred speech
  • Slow breathing
  • A blue colored tint of the skin
  • Low body temperature
  • Seizures
  • Unconsciousness

Trauma and Car Crashes

We encourage to drive safely every day of the year but especially during the holidays as trauma and car crashes are among the top holiday medical emergencies.  According to information from the National Highway Traffic Safety Administration, the month of December can be especially dangerous for motorists.

The week between Christmas Eve and New Year’s Day is considered one of the most dangerous and deadliest weeks of the year for drivers. More people on the roads, stress, weather conditions and alcohol consumption are all contributing factors for road accidents.

 

  • 40% of deaths during the last week of the year involve at least one drunk driver
  • Drivers between the ages of 21 and 24 tend to be more often involved in fatal crashes related to alcohol use. The second highest age group was drivers between 25 and 34 years old.

 

Any person involved in a car crash regardless of whether alcohol was involved or not should be brought in to our Emergency Room immediately for evaluation. Remember insurance companies are required by law to cover ER visits for car crashes.

Sprains, Broken Bones and Concussions

It seems the number of falls increases during the holidays, from falling while putting up Christmas decorations, slipping and falling while running errands, to kids falling off their new bikes, and skateboards, the truth is at our Emergency Centers we see a fair share of sprains, broken bones, and concussions during the last few days of the year.

 

You should pay us a visit when:

  • You suspect you or a loved one has a broken bone
  • You have fallen and hit your head and lost consciousness, are feeling dizzy, have trouble remembering things, have difficulty speaking, as you may have a concussion
  • If you have difficulty walking or are suffering from severe pain

Overeating

We are all guilty of overindulging during the holidays. Those special dinners and Holiday treats, however, can give us some nasty scares and some real problems. In fact, the CDC has stated that abdominal pain is the single most common reason that American patients visit the ER, accounting for seven million visits per year

According to a study by the American Heart Association, overeating makes you four times more likely to experience chest pains or worse suffer a heart attack.

 

Additionally, people who overeat during the Holidays:

  • Are 10 times more likely to visit the ER
  • Run the risk of requiring emergency stomach procedures
  • Increase their risk of having food stuck in their esophagus

Whenever you experience chest pains, shortness of breath, or severe abdominal pain you should rush to the ER for evaluation, don’t wait it out.

Allergic Reactions

During the Holiday Season, people who suffer from allergies are exposed to many triggers, from Christmas trees, mold, scented candles, and of course food.

For most of us allergic reactions are mild and can be treated with an over the counter antihistamine, however, in some cases, our immune system’s response can be severe enough to cause an asthma attack or a life-threatening anaphylactic shock.

Severe asthma attacks or cases of anaphylactic shock require immediate medical attention, all Altus Emergency Center locations will be open every day during this Holiday Season to attend such emergencies.

Kitchen Related Injuries

There’s a lot of food preparation that goes on during Christmas and New Year’s, and in our eagerness to create those spectacular meals, we could end up cutting or burning ourselves.

Hopefully most cuts and burns will be superficial and won’t require medical attention, however, if your wound is deep enough as to where you can see bone, cartilage, or tendons you need to come in for stitches, and if you have second or third degree burns you must come in to the ER immediately.

 

Altus Emergency Centers wishes everyone in the communities we serve a Merry Christmas and a Happy New Year. And we would like to remind you that we will be available to treat any medical emergency that arises.

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!

Don’t Fall Prey to Insurance Company Fear Tactics

Don’t Fall Prey to the Insurance Company Fear Campaign

A study from the Doctor Patient Rights Project (DPRP) has revealed a disturbing trend amongst large insurance companies.

In the study, the DPRP singled out a company named Anthem Blue Cross – Blue Shield, which through its affiliated networks is the nation’s largest private health insurer. The findings in the study claim that Anthem has been retroactively denying insurance claims for emergency room visits from its clients, especially those who are from low income or rural areas.

The DPRP concluded that the purpose of Anthem’s policy is to make its clients too afraid to go to the ER out of fear that they will not be covered and must pay the whole bill out of pocket, which most patients are unable to do.

This conclusion is widely shared by the physicians and administrative staff of Emergency Rooms across the country as put in evidence by the comment of Dr. Ryan Stanton a critical care and emergency medicine specialist in Lexington, Kentucky,

“The purpose of this program is to spread fear.”

What is Anthem Blue Cross – Blue Shield Doing?

Last year, Anthem started notifying its clients in certain parts of the country, that if their ER visits end with a diagnosis for something that isn’t an emergency, they would be responsible for 100% of the cost of their visit.

The problem with this policy is that most of us don’t have enough medical knowledge or training to self-diagnose before going to the ER. According to The American College of Emergency Physicians (ACEP), there is nearly a 90-percent overlap in symptoms between emergencies and non-emergencies, according to a study in the Journal of the American Medical Association (2013). These symptom overlaps make it extremely difficult for any of us to determine the difference between abdominal pain that is life-threatening and abdominal pain that isn’t.

The fear factor that Anthem is creating with their denial policy means more people will choose to wait and see if their symptoms improve before seeking immediate emergency medical attention, a decision that could lead to lifelong disabilities or even death.

PROTECT YOUR RIGHTS!

The Law is on Your Side

The policy is so outrageous and dangerous to the public, that it has even reached the Senate. As reported by CBS News, Sen. Claire McCaskill, D-Missouri, sent a letter to both the U.S. Department of Health and Human Services and the Department of Labor asking them to investigate whether certain health insurers had violated the Prudent Layperson Standard.

The Prudent Layperson Standard which was added to the group and individual health insurance plans in 2010, and it requires health insurance companies to cover emergency room visits based on symptoms and not the final diagnosis. It also eliminates the requirements for prior authorization before seeking emergency care.

In our state, the Texas Department of Insurance requires insurance companies to pay emergency facilities like Altus Emergency Centers, the same way they would bill a facility which is part of the insured’s in-network. In other words, your insurance company should cover the same amount regardless of what type of emergency facility you visit, they cannot provide you with a lower benefit level.

The Patient Protection and Affordable Care Act also added numerous patient protections, most notably, they now require health plans covering emergency services to provide such coverage without the need for prior authorization.

Furthermore, health plans are required to pay for emergency visits for medical situations in which an average layperson believes his or her health is threatened. The final diagnosis should not influence whether the insurer pays for the emergency room visit or not, and insurance companies cannot legally apply the claim towards the out-of-network benefits.

What Can You Do If Your Claim is Denied?

The first thing you should do is contact our Patient Advocate Department. Our staff will review your denial and process an appeal on your behalf; they will submit documentation and justification for any ER treatment that you received.

If you get denied a second time, you still have the option to request an external review by a third-party, which will most likely be the state insurance regulator.

The appeal process is lengthy and labor-intensive because the goal of the insurer is for you to give up. Regardless of how long it takes you should continue with the process because the law is on your side.

Don’t fall victim to these scare tactics being implemented by insurance companies. If you have any concerns about the emergency medical coverage of your health insurance plan, our Patient Advocate can help clear these and even arrange to speak directly to your health insurance agent on your behalf.

Altus Emergency Patient Advocates are here to help you.  We help you decipher the complexity of the medical industry to uncover how it can be most beneficial to you.  We have focused our 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 contact our Patient Advocate Department.  Please feel free to call 469-383-7361 between 8:00 am and 5:00 pm and ask for the Patient Advocate.

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.

Insurance Companies Must Cover ER Trips Involving Traffic Accidents

Insurance Companies Must Cover ER Trips Involving Traffic Accidents

Danger on the Road – Traffic Accident Statistics

With nearly 264 million vehicles registered and over 218 million individuals with a valid driving license, our roads are some of the busiest in the world. This, unfortunately, means traffic accidents are more common than any of us would like.

Annual Car Accidents in The United States

Every year the National Highway Traffic Safety Administration (NHTSA) issues a briefing based on reported car accidents nationwide. The NHTSA keeps track of injuries, fatalities as well as the factors which might have contributed to the crash such as speeding, alcohol, and distractions.

From these reports we can gather the following statistics:

  • There are more than 6 million reported car crashes a year in the United States
  • An estimated 37,133 people lost their lives in motor vehicle-related accidents in 2017
  • 18,720 people have died between January and June of 2018 according to the National Safety Council

The Impact of Motor Vehicle Accidents in Texas

Data from the National Highway Traffic Safety Administration, the state of Texas has the most traffic fatalities of any state in the country.

  • In 2017 there were 3,407 fatal car crashes reported
  • 3,722 people lost their lives due to a car crash related incident in 2017
car accident trauma emergency

Most Common Causes of Traffic Accidents

Distracted Driving

Distracted driving is the leading cause of road accidents in America. Drivers can become distracted by several things while driving:

  • Cell phones
  • Eating
  • Drinking from a mug or bottle
  • Talking
  • Children
  • Pets in the car

Not paying attention to the road while driving can have dire consequences; the NHTSA reports 3,166 fatalities in distraction-affection crashes in 2017. There were also an estimated 795 deaths due to drowsy driving last year.

In addition to these tragic deaths, thousands of victims who experience long-term disabilities.

Speeding

The second most common cause of road accidents in the United States is speeding, and because most of these accidents typically occur at high speeds, it is also a significant cause of traffic accident-related deaths with an estimated 9,717 deaths in 2017.

Drunk Driving

Road accidents involving drunk drivers are another major cause of injuries and fatalities, especially during the weekend and holidays. Drinking slows down our response time and our ability to focus on the road, and it can also make us drowsy.

According to data from the NHTSA,

“29% of the total fatalities of road accidents were in alcohol-impaired-driving crashes.”

In our own state of Texas:

Out of the 3,722 road accident deaths in 2017, 1,468 or 39% of them occurred in an accident caused by a drunk driver.

Getting Prompt Medical Attention Can Help Save A Life

According to the CDC for every person killed in a road accident,

“8 were hospitalized, and 100 were treated and released from the Emergency Room.”

Anyone who is involved in a severe motor vehicle accident should be taken to the nearest Emergency Room for evaluation, given that some injuries can only be diagnosed with advanced imagining technology.

During a crash, victims might have suffered internal injuries or head trauma that if not treated promptly can lead to long-term disabilities or even death.

Some injuries are more time-sensitive than others, in these cases it is better to transfer the patient to a Free-Standing ER facility such as any of the Altus Emergency Centers where they can be treated by a licensed emergency physician right away, rather than transport them to a Hospital ER where their treatment might be delayed due to overcrowding issues.

It’s important to remember that insurance companies are obligated to offer emergency room coverage in their policies. If you are involved in a car accident and need to go to the emergency room, your insurance policy will cover your visit.

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.

HEALTH NEWS, EVENTS & MORE.

Online Medical Technology

heartBEATRed

🦟 ⚠️ The @TexasDSHS recently confirmed the 1st human case of the West Nile Virus for 2019.
🔎 https://t.co/KjOWZsVWde
👨‍⚕️ Learn how to Prevent Common Mosquito-Borne Illnesses.
🚨 Recognize any Symptoms?

🏥 #AltusERCenters Open 24/7, No Lines.

🇺🇸 GOD BLESS AMERICA! Land of the Free, Because of the Brave!
🎇 Have a Healthy & #HappyFourthOfJuly From All of Us!
🏥 At #AltusERCenters, We're Open 24/7, No Lines through the 4th of July Weekend over all of our four locations.
👨‍👩‍👧‍👦 Accepting TRICARE.
#HappyIndependenceDay

4

Facebook

1 day ago

Altus Emergency Centers

SUPPORTING OUR HEROES, FIRST RESPONDERS. 🚑🚓🚒

👏 We had the honor of attending the Greater Angleton Chamber of Commerce's Salute to First Responders Luncheon.

👩🏻‍⚕️Two of our nurses Heather and Rhonda attended by representing Altus Emergency Center in a "THANK YOU" to our first responders!

🏥 #AltusERLakeJackson Open 24/7, No Lines.
... See MoreSee Less

View on Facebook