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
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.
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.
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.
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.
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
Your visit to Altus Emergency just saved you: $1,183.37
SCENARIO 2: ABDOMINAL PAIN
Your visit to Altus Emergency just saved you:Altus Savings of $1,389.19
SCENARIO 3: BACK/FLANK PAIN
Your visit to Altus Emergency just saved you: $2,627.52
SCENARIO 4: HEAD INJURY
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) 732-3151 between 8:00 am and 5:00 pm and ask for the Patient Advocate.
Baytown & Lake Jackson: Call us (832) 241-5680 between 12:00 pm and 7:00 pm and ask for the Patient Advocate.