Our Billing Process
At Sacred Heart Emergency Center, we strive to make the billing process as smooth and transparent as possible. We owe that to our valued patients. Though Sacred Heart Emergency Center is not a participating provider in any health benefit plan provider network,. In other words we are considered “out of network”. However, by state law, all insurance carriers are required to process your ER visit at in-network benefits levels or they are to pay according to out of network benefits require. (see “Know Your Rights” below). Here is how our process works.
After you have been seen at our facility, our billing department will submit two claims to your insurance company. The first will be from the physician who cared for you and the second will be for the facility in which you were seen. The facility charge will include all lab tests, x-rays, CT scans, cultures, etc. that you may have received. Do not expect to see a separate bill from a third party for these services.
After we submit the claims to your insurance carrier, you will receive an explanation of benefits (EOB) from your insurance company. Keep in mind that this is not a bill so please do not be misled. This EOB will explain the charges from our facility with regard to the emergency care you received. These charges will be negotiated on your behalf. The EOB may itemize your copay, deductible and co-insurance, as well as your potential payment responsibility. The EOB is only an initial step and most likely does not represent what the final settlement will be. In fact, our billing department will appeal and negotiate as much as they can, over several months if necessary, to come to a fair resolution.
After the final EOB has been processed, and if there is an outstanding balance due, you will be sent a single invoice with both the facility and physician charges all summarized into a single amount due. Please don’t panic if you don’t see a bill. Sometimes, negotiations with insurance companies take several months. If you have any questions about your invoice, please do not hesitate to call or email your patient advocate. We frequently offer courtesy discounts or other payment options. Sacred Heart Emergency Center does not engage in the practice of balance billing also known as “surprise billing”. Our goal is to provide great care and fair billing so you are comfortable bringing yourself or a family member back in case emergency care is needed.
Emergency Room Billing and Insurance Coverage
Because CMS does not yet recognize Freestanding Emergency Departments, Sacred Heart Emergency Center cannot accept Medicare, Medicaid, or Tricare at this time. We are working with the Texas Association of Freestanding Emergency Centers (TAFEC) to change this status.
Know Your Rights
The Texas Department of Insurance Code, Section 1301.155 on Emergency Care requires that insurance companies pay emergency facilities “at the insured’s in-network benefit level” (i.e., use in-network deductibles, co-pays and co-insurance rates) for all emergency services. Also, because the Affordable Care Act (ACA) defines emergency care as an essential healthcare benefit, a person cannot be penalized for receiving emergency care at a Freestanding Emergency Center. Sometimes insurers attempt to avoid these ACA (or other) payment obligations and this can sometimes result in annoying billing issues for patients. If this happens to you, please contact us right away and we can help address the inaccurate billing by your insurance provider. Sacred Heart Emergency Center does not participate in Balance Billing. Please know that Sacred Heart Emergency Center will never bill you for anything above your “in-network” rate.
We are your advocates.
Care from Sacred Heart Emergency Center doesn’t end when patients leave our facility. Our Patient Advocate team is there for you to help navigate insurance, billing, reimbursement, and just to make sure you are doing well. We strive to create a seamless, stress-free process so you can have more time for your busy life and family.
Per Senate Bill 425, which took effect September 1, 2015, and House Bill 3276, which took effect September 1, 2017, the following notice must be posted:
- This is a freestanding emergency medical care facility.
- This facility charges rates comparable to a hospital emergency room and may charge a facility fee.
- This facility is not a participating provider in any health benefit plan provider.
- However, by state law, your health insurance company is required to process your emergency medical care at in-network benefit levels.
- The physician providing medical care at this facility may not be a participating provider in the patient’s health benefit plan provider network.
- The physician providing medical care at this facility may bill separately from the facility for the medical care provided to a patient (this is not the case at Sacred Heart Emergency Center).