Insurance Benefits & Coverage
Advance ER is a state-of-the-art emergency medical facility located in Texas, dedicated to providing high-quality care to our patients. We understand that navigating insurance coverage and understanding what insurance is accepted can be a complex process, which is why we’re committed to making it simple and straightforward.
We honor in-network benefits, which means that if you have insurance through one of our participating providers, you’ll receive the highest level of coverage and benefits. Some of the in-network insurance providers we work with include Blue Cross Blue Shield, United Health Care, and many other private insurance companies.
In addition to these in-network providers, we honor all commercial insurance, other private insurance plans, and workers comp.
At Advance ER, we believe that everyone deserves access to quality medical care, regardless of their insurance status. That’s why we work with patients and insurance companies to help minimize out-of-pocket expenses and reduce financial barriers to care.
Here is a list of insurances we accept, call our office if you ever have any questions about coverage.
- Blue Cross Blue Shield
- (Federal Employee Program) Blue Cross Blue Shield
- Anthem Blue Cross Blue Shield
- United Health Care
- Golden Rule
- Ambetter Marketplace
- Baylor Scott & White
- Western Health
- Boon Chapman
- First Health
- Molina Marketplace
- Freedom Life
How Insurance Coverage Works
Insurance companies often have a network of healthcare providers, including emergency facilities, that they have contracts with. If you seek treatment at an in-network emergency facility, your insurance will typically cover a larger portion of the costs. Out-of-network facilities might still be covered, but the insurance might pay a smaller percentage, leaving you responsible for a higher portion of the bill.
Your insurance plan may have a co-payment (a fixed amount you pay for a specific service), co-insurance (a percentage of costs you're responsible for after meeting your deductible), and a deductible (the amount you pay out-of-pocket before your insurance starts covering costs). These factors affect how much you'll pay for emergency services.
Remember, insurance plans often have specific criteria for what qualifies as an emergency medical condition. Services received for these conditions are typically covered differently than non-emergency services.
In some cases, insurance companies might require prior authorization for emergency services to ensure they're medically necessary. However, in emergencies where immediate care is needed, this step might be waived or handled retroactively.
In Texas, if a patient receives services from an out-of-network provider at an in-network facility (like anesthesiology or radiology services during a procedure), they are protected from excessive balance billing.
After receiving emergency services, you'll get an EOB from your insurance company detailing the services provided, what was covered, and what you're responsible for paying. Reviewing this document helps understand your financial obligations.
If your insurance denies coverage for emergency services, you have the right to appeal the decision. This involves providing additional information or contesting the decision.
Guidelines for Texas Emergency Rooms
In Texas, balance billing, particularly in emergencies, has garnered attention, and the state has implemented certain regulations to protect patients from excessive billing by out-of-network providers. The Texas Balance Billing Protection Act aims to shield patients from surprise medical bills when they receive emergency care or undergo treatment at in-network facilities but inadvertently receive care from out-of-network providers.
According to Texas law, insurance companies must cover emergency medical treatment for their members, even if the facility is considered "out-of-network." You have the right to use the "prudent layperson standard" when determining if you have a medical emergency. Emergency care is defined as care for conditions that a person with average medical knowledge would consider to be a serious threat to their health if not treated immediately. Your insurance must reimburse you for emergency treatment, and if they refuse, you can file a complaint with the Texas Department of Insurance. Freestanding emergency centers must provide medical screening and stabilization patients regardless of their ability to pay. For more information on Texas insurance laws, visit the Texas Department of Insurance website.
For additional info about the Texas Department of Insurance, go to http://www.tdi.state.tx.us.
If you have any questions about insurance coverage or accepted insurance plans, please don’t hesitate to reach out to us. Our friendly and knowledgeable team is always here to help, and we’ll do everything we can to make sure you get the care you need.
We look forward to serving you at Advance ER and ensuring that you receive the highest level of care possible. Give us a call at (214) 494-8222 if you have any questions.