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Understanding ER Billing

Every time you visit a doctor, hospital, or emergency room you’re always asked to complete long forms with all your health insurance information. This information is then filed with a copy of your health insurance card. But do you know what happens next? Today we’ll discuss the most common ER billing questions patients have for their health insurance providers.

How Health Insurance Billing Works

So what happens between you providing information and your insurance provider picking up the bill?

A health insurance claim is filed. A health insurance claim is a bill to your health insurance company for medical services you or a covered individual receives. Your insurance company agrees to pay this claim based on our benefit coverage. Typically, you have a copay (a set dollar amount) or co-insurance (a percentage of the claim) due for services rendered. You pay a small part of the medical bill and your insurance company covers the rest.

Everyone Receives Emergency Room Benefits

Your health insurance plan includes benefits for emergency room visits. In fact, the state of Texas requires that your insurance provider cover your visit to any emergency room of your choice. When you’re experiencing a medical emergency, the decision of where to seek care is completely in your control. Your health insurance company must honor out of network benefits for your ER visit.

When you complete the admission paperwork for the emergency room, you will be asked to pay your insurance policy’s co-pay or your estimated co-insurance at the time of your visit. Ask your admissions clerk about the billing options offered by the emergency room you are visiting. Some emergency rooms, like Advance ER, honor in-network billing even if they are not a part of your health insurance coverage network. Knowing these details can help you work to reduce the total claim made to your insurance company.

Explanation of Benefits Are Not Bills

The ER billing process starts as soon as you leave the emergency room. You will receive an Explanation of Benefits or EOB in the mail. This required document lists the services you were provided during your ER visit and the associated costs.

The Explanation of Benefits is not a bill. This document is used by your emergency room billing department to generate the claim for your insurance company. If your insurance company determines you owe more than the amount already paid for services, they will make you aware of your financial obligation.

Why You Receive Separate Bills from Emergency Room Departments

Emergency room departments that are attached to hospitals rely on the services of the facility to treat emergency room patients. When you visit a traditional ER department your insurance will be billed from the facility and the physician. You will also be billed by each separate department that treated you: the pharmacy, x-ray, ultrasound or others. Most hospital departments are separate legal entities that operate in one building, therefore they must bill separately.

Standalone emergency rooms like Advance ER eliminate the problem of multiple claims for your visit

Most standalone emergency rooms bill your insurance company for any services from medical imaging or other departments as a part of the facility bill. The physician still makes a separate claim, resulting in only 2 claims for your visit. By combining billing, standalone emergency rooms help expedite the processing of your claim.

What other areas of emergency room billing do you find confusing? Call us today to answer your questions