Guidelines set by the state of Texas mandate that insurance carriers are required to pay in-network benefits to members receiving emergency medical treatment. It is Texas law that your insurance provider pay for your emergency room treatment, even if the provider typically classifies the facility as “out-of-network.” You are empowered by Texas state law to use the prudent layperson standard when deciding if you are having a medical emergency.
Your insurance provider is required to reimburse you for emergency treatment. If your insurance company is refusing to reimburse you for your emergency room visit, you may file an official complaint with the Texas Department of Insurance. For additional info about the Texas Department of Insurance go to https://tdi.texas.gov/.
For more information about Senate Bill 425, click here.
You will not be balanced billed for your emergency medical treatment received at our facility. “Balance billing” is the difference between the billed charges and what your commercial health insurance plan allows. Your commercial health insurance plan will determine if you will be required to pay any deductible, coinsurance, and/ or copay amounts.
“Commercial health insurance plans” are healthcare policies that are not administered by the government. Your commercial health insurance plan will be billed if all applicable consents and forms are signed.