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MAGNOLIA & WOODLANDS
Frequently Asked Questions
BILLING & INSURANCE
For any billing or insurance questions you may have, please contact our billing department toll-free at (832) 658-2211 or by email at firstname.lastname@example.org. We look forward to serving you.
Do you accept my insurance?
We file with all major private insurance such as Aetna, Blue Cross/Blue Shield, Humana, Cigna, United Healthcare and others. While we are not a Medicaid provider at this time, our Urgent Care Center does accept Medicare.
What if America’s ER is not in my network?
Many insured patients inquire regarding the cost of services provided in “in-network” versus “out-of–network” emergency rooms. For all commercially insured patients, the answer is simple – no matter what emergency room you seek care in, both state and federal law prevents insurance companies from making you pay more for copays, deductibles and coinsurance. That means that under your plan, all emergency rooms are financially identical – “in-network” or “out-of-network”, you’re responsible for paying the exact same amount under your plan – not a penny more. So, from the standpoint of cost, there is no difference between an “in-network” and “out-of-network” emergency room to a patient with insurance – they are all (every single one of them in the country) the same. That means you and any other insured patient, can go to any emergency room you wish (the one you like, and that you feel is best for you and your family) without the fear of being responsible for larger copays and deductibles in one versus another – your benefits are applied in the same way – there’s no difference in cost to you.
Why is this the case? These laws are designed to keep a patient seeking care focused on finding that care as expeditiously as possible free from the fear of being financially penalized by their insurance company.
In fact, since it opened its doors in 2014, America’s ER has always sought to minimize its patients’ out of pocket expenses. As a result, in all that time, and having seen tens of thousands of patients, America’s ER has never balanced billed a single patient – not one. Instead, we have worked day in and day out since opening, challenging insurance companies any time they’ve tried to shift their legally dictated financial responsibility to our patients, and we will continue to do so in order to keep the direct cost to our patients as small as possible.
So, don’t let insurance companies fool you into limiting your healthcare choices. Just remember….
- No matter what emergency room you chose, you’re always entitled to your plan’s “in-network” benefits;
- An explanation of benefits from your insurance company (an “EOB”) is not a bill from America’s ER, and likely does not accurately reflect what you may owe;
- America’s ER has never balanced billed a single patient – not one.
How is my bill calculated?
America’s ER Medical Centers (“AER”) is publishing its service fees to help our patients understand both their healthcare costs as well as what their health insurance companies are required to cover. While AER is solely responsible for the fees appearing on its charge master, AER derives those fees from the licensed Emergency and Urgent Care charge data it receives from Fair Health, Inc. (“Fair Health”).
Fair Health is an independent and neutral, national nonprofit organization. It is neither affiliated with nor controlled by healthcare insurance companies or healthcare providers. In fact, Fair Health was specifically created to increase transparency to consumers like you by providing non-biased and accurate information regarding the cost of healthcare services you’d expect to find in your community. In fact, the Texas Department of Insurance recently selected FAIR Health to provide healthcare cost benchmarks data to support the state’s price transparency initiative. Fair Health can offer consumers this reliable information because each year, health insurers around the country send it over a billion healthcare bills which are added to its ever growing database of more than 25 billion healthcare claims. Fair Health maintains the accuracy of healthcare information by making its data specific to the geographical area where healthcare services are provided and by updating that geographically specific healthcare data twice a year.
While Fair Health retains all rights in and to the information in its healthcare database, AER utilizes that accurate and non-biased data to establish and regularly update its usual and customary charges so those charges always approximate the costs listed in the 80th percentile of Fair Health’s charge data. Fair Health’s healthcare information, including the data used by AER to develop its service fees, is publicly available to everyone at Fairhealthconsumer.org.
While Fair Health does not publish charge data for professional services rendered in an emergency room, AER utilizes the facility charge data that is published by Fair Health to establish its usual and customary professional service charges. This charge approximation is accomplished by attempting to employ the same methodology used by the Centers for Medicare and Medicaid Services (“CMS”) to determine reimbursement for professional services rendered to CMS patients.
What will I pay if I use my insurance?
As with any Emergency Room, Urgent Care clinic or Doctor’s office, we collect a copayment (copay) at the time of service, which varies in cost based upon your specific policy and whether you received treatment in the Emergency Room or Urgent Care Center.
After your insurance company has processed your claim, any additional out-of-pocket expenses you may incur are based upon the specific terms of the policy you purchased. For example, you may be required to pay a deductible or co-insurance they deem is your responsibility. Knowing the details of your specific policy can help you make informed decisions regarding your medical care.
How are claims processed?
On your behalf, our billing specialists will submit your claim to your insurance company. After your visit you will receive an “Explanation of Benefits (EOB)” detailing the benefits paid out based on your specific plan and what they claim you owe—including amounts applied to your remaining deductible or any co-insurance. You may even receive more than one EOB, such as one for the facility and one for the physician. It is important to know these EOBs are NOT bills, and you may not actually owe what is indicated.
Please call us upon receiving your EOB, so we can check the status of your claim and ensure it has been processed correctly. The claims process can take time, as appeals may be made to negotiate reimbursement. Our friendly staff will gladly answer any questions you may have, clarify what you actually owe, and will work with you each step of the way to make the experience as easy and convenient as possible.
What if my insurance company denies my claim?
If you feel you are experiencing an emergency and seek treatment at any emergency department, including America’s ER, your insurance company is required by federal law to pay for your care at in-network rates—even if the facility you visit is out-of-network. If your insurance company refuses payment for your visit, you can file a grievance with the Texas Department of Insurance. Please visit www.tdi.state.tx.us to learn more. In addition, our billing specialists will file an appeal with your insurance company on your behalf and will handle the entire appeals process for you.
I received an Explanation of Benefits (EOB) after my visit. Is this my bill?
After your visit, your insurance company will mail you an “Explanation of Benefits (EOB)” detailing the benefits paid out based on your specific plan and what they claim you owe—including amounts applied to your remaining deductible or any co-insurance. You may even receive more than one EOB, such as one for the facility and one for the physician. It is important to know these EOBs are NOT bills, and you may not actually owe what is indicated.
Please call us upon receiving your EOB, so we can check the status of your claim and ensure it has been processed correctly. The claims process can take time, as appeals may be made to negotiate reimbursement.
How do I pay if I don’t have insurance?
For patients who do not have insurance or do not want to use it, we offer a substantial discount when payment is made in full at the time of service. All major credit cards, such as MasterCard, Visa, American Express and Discover are accepted.
Are Freestanding Emergency Rooms more expensive than hospital-based ERs?
Charges for care in both facilities are essentially the same. In fact, America’s ER transparently makes our charges public by setting them at the 80th percentile of the Fair Health Database. Fair Health is an openly available online national database comprised of the average charges for each and every treatment code and procedure.
Senate Bill 425 relates to healthcare and fees charged by freestanding emergency centers. America’s ER Emergency Centers are freestanding emergency medical care facilities that charge rates comparable to hospital ERs and may charge separate facility fees. Patients may also be treated by physicians who are out of network and/or may be billed separately by the physician providing medical care. America’s ER Emergency Center complies fully with this law.
Does Urgent Care cost the same as ER care?
No! Because we have both an Emergency Room and 24/7 Urgent Care Center, we are able to bill patients based on the severity of their condition and which department they receive medical treatment. Urgent Care is billed at urgent care rates, and Emergency Care is billed at ER rates.
What is a Facility Fee and how is it different from a Professional Fee?
A Facility Fee is a service fee charged by a healthcare facility to cover the cost of operating and staffing the emergency room and hospital 24/7/365. These overhead costs allow to provide our services to include but are not limited to utilities, supplies, providing and maintaining advanced diagnostic equipment, employing qualified nursing personnel and support medical and administrative staff, as well as the facility itself.
A Professional Fee is the cost for services provided by the physician.
URGENT CARE SERVICES
Please call us at (281) 305-4304 to speak with our friendly staff about any questions you may have related to our urgent care services.
Will I be treated in the Urgent Care Center or ER?
Our experienced doctors will perform a free medical screen on every patient to evaluate their condition and determine whether they need to be treated in the Emergency Room or Urgent Care Center. His decision is guided by protocols based on the Emergency Severity Index (“ESI”), a triage tool developed by the Agency for Healthcare Research and Quality, endorsed by the American Medical Association and utilized in ERs across the nation to determine if a patient’s condition warrants emergency treatment.
What’s the difference between an Urgent Care Center and an Emergency Room?
Unlike Emergency Rooms, Urgent Care clinics are unlicensed and unregulated healthcare facilities in most states. Because they are not required to have on-site physicians providing direct patient care, many urgent care clinics are staffed with nurse practitioners or physician assistants. In contrast, Emergency Rooms are required by law to be staffed with on-site physicians who have extensive experience in pediatric and adult emergency medicine and are current on all certifications.
Also, due to the lack of stringent regulations, the clinical capabilities of urgent care centers vary among facilities and can be quite limited in nature. Because they are unlicensed, some are not equipped with diagnostic imaging or a CLIA-certified laboratory to help ensure proper diagnoses.
And lastly, urgent care clinics typically have limited hours of operation, and they treat conditions that are less severe than those requiring treatment in the emergency room. Therefore, the fees associated with urgent care services are less expensive than emergency rooms.
The Urgent Care Center at America’s ER is vastly different from others. We are open 24/7 for your ultimate convenience. And because of the strict state regulations followed by our Emergency Room, which is located under the same roof, we provide access to state-of-the-art equipment and high quality medical care by on-site experienced ER board-certified physicians. Wondering about cost? Treatment in our Urgent Care Center is billed at urgent care rates—not ER rates.
Does Urgent Care cost the same as treatment in the ER?
No. Because we have both an ER and 24/7 Urgent Care Center, we are able to bill patients based on the severity of their condition and which department they receive medical treatment. Urgent Care is billed at urgent care rates, and Emergency Care is billed at ER rates.
Are you affiliated with any hospitals or family practice groups?
When our patients need follow-up care with either a primary care physician or specialist, we are happy to arrange a timely appointment with a physician in our growing referral network. In most cases, you will be able to see that doctor within a few days of leaving our facility, as opposed to waiting weeks for an appointment. We also have relationships with area hospitals and pharmacies to help you address all of your healthcare needs.
Do I need to make an appointment to be seen?
Our Urgent Care Center is open 24/7 and you never need an appointment for any of our services. Stop by when it’s convenient for you, and we’ll take care of you with little to no wait.
Are you in-network?
We are in-network with most major insurance providers and have affordable options available for all patients.
Will my doctor or my child’s pediatrician be notified of my visit?
If you would like us to discuss your visit with your doctor or child’s pediatrician, we are happy to do so. Seamlessly managing your care with your other healthcare providers is part of the service we offer our patients. Just provide us with your doctor’s contact information at the time of your visit, and we will forward your physician the requested medical information.
Please call us at (281) 305-4304 to speak with our friendly staff about any questions you may have related to our laboratory services.
Are appointments required?
Appointments are never required for any of our services. However, you can always call to let us know you are coming. Simply stop by whenever it is convenient for you—day or night.
Do I need a physician’s order for lab testing?
Nearly all lab tests require a physician’s order or prescription to be performed. We do provide patients the option to be evaluated in the Urgent Care Center by our attending physician, who can order any needed tests.