Insurance FAQ

We understand that insurance terms can be confusing. We want to help provide you with answers to many questions you may have regarding how insurance works, especially when you have the need for unforeseen emergency care.

Understanding Basic Terms:

Copayment (“Copay”): This is a fixed dollar amount that is set by your insurance company depending on the plan that you or your loved one chose to enroll in. This payment will vary depending on what setting a patient is being evaluated in, such as your primary care physician’s office, a specialist’s office, or an emergency room. This could be $15, $50, $100, or more depending on the plan that you have chosen. Usually, copays do not apply to your deductible. These amounts are not determined by the care provider/physician. Check with your insurance company as to whether or not they apply your copayments to your deductible.

Deductible: The amount that the patient or patient guarantor is responsible for paying for medical expenses before your health insurance plan begins to pay for covered medical expenses annually. This amount is determined by the insurance company and the patient is enrolled in a certain insurance plan. These amounts are not determined by care providers/physicians.

Coinsurance: This may be one of THE most confusing terms with regards to health insurance. Once you have met your annual deductible, many insurance companies share the cost of care with you. This is called “coinsurance”. Most plans offer a 10% or 20% coinsurance. If your plan has a 20% coinsurance, then your insurance company will cover 80% of your covered medical expenses. It is important to remember that this only applies after you have met your deductible.

Maximum Out of Pocket Expense: This is the maximum amount that you will have to pay via coinsurance and deductible before your insurance plan pays 100% of covered medical expenses. Some insurance plans do offer 100% insurance after the deductible is met, in which case you would not have coinsurance at any time.

In-Network: Insurance companies often develop contracts with various providers and negotiate rates/amounts that they will pay for various services to that physician or facility. Physicians or facilities that have contracts with an insurance company are considered “In-Network”.

Out of Network: This refers to any facility or physician that has not contracted with your insurance plan on rates they will pay for various services. Texas state law does require your insurance company to cover Emergency Care as if it were “In-Network” even if the facility or physician is considered “Out of Network”. It is important to understand that non-emergency visits to an ER may not be covered by your insurance plan at the in-network rate.

What does this all mean for you?

At Family ER + Urgent Care, we want you to make sure that you and your loved ones are treated with the utmost respect, compassion, and fairness. We are committed to providing the highest quality emergency care on the market and billing you appropriately for services rendered.

At any time you visit our facility, our physicians will explain to you whether or not you have a potential “Emergency Medical Condition.” If you have an Emergency Medical Condition, we will complete the care until you are discharged or transferred to a hospital for admission, regardless of your ability to pay. We care about YOU first!

I have private insurance (Blue Cross/Blue Shield of Texas, Aetna, Cigna, etc):

  • Currently, Family ER + Urgent Care and Family ER + Urgent Care physicians are out of network providers. However, state law mandates that your insurance plan cover your emergency care as if it were “in Network” whether or not you choose an “In-Network” or “Out of Network” Emergency Care provider.
  • Emergency Care in the State of Texas is determined by the “Prudent Lay Person Standard.” This means that if the average non-medical individual would consider your condition an emergency, then your insurance should cover you as if you were visiting an “In-Network” provider/facility.

From 8 am to 8 pm Urgent Care*:

  • Between the hours of 8 am and 8 pm, if you present to our facility and our Emergency Physicians determine that you do not have a medical emergency, you may be able to seek care at our Urgent Care facility on the premises.
  • Because we are a full service Emergency Room, legally, we are required to charge you the Emergency Room Co-Pay. However, as a Fast-Track patient, your responsibility for Deductible and Co-Insurance will be much lower.
  • Our registration staff will verify your insurance benefits during your visit. They will be able to provide you with an estimate from the physician as to what you will be responsible for paying for your care.
  • You may choose to pay the self-pay rate and not file with your insurance if you desire. This could be as low as $150.

Emergency Care and After Hours:

  • If you visit our facility at any time of day and our Emergency Physicians determine that you have a potential “Emergency Medical Condition”, we will inform you of our plan for your care. If you visit after 8 pm, this will automatically be considered Emergency Care. However, if our physicians feel that you can wait to see your doctor in the morning, they will give you that piece of mind free of charge.
  • If you have an Emergency Medical Condition, we will collect your co-pay and you will have the opportunity to pay the portion of your estimated deductible.
  • Once our billing company has assessed all of the charges, they will bill your insurance company and you will be informed of any remaining deductible or co-insurance charges.
  • If you choose, you may opt to pay a discounted rate at the time of service in full.   This will not be billed to your insurance company. However, you will be able to submit your payment to your insurance company to apply towards your deductible.
  • Since all insurance companies are different, we can never guarantee that the estimate we provide at discharge is accurate. However, we will do our best to give you a rough estimate of the bill you may receive.
  • If you are unable to pay your bill in full when it arrives, please contact our billing company and they will assist you with a payment plan.

I have insurance, BUT I have a high deductible plan greater than $2500:

  • Family ER + Urgent Care understands that no one anticipates that they will need emergency care and that this can impose an unforeseen financial strain on our patients.
  • Our registration staff will inform you and your physician of your remaining deductible and will provide you with an estimate of what will be sent to your insurance company.
  • If you choose, you may opt to pay a discounted rate at the time of service in full. This will not be billed to your insurance company. However, you will be able to submit your payment to your insurance company to apply towards your deductible.
  • If you choose to pay in full at the time of service, then our billing company will provide you with the necessary documentation to submit to your insurance plan for credit towards your yearly deductible.
  • We highly recommend you read and understand your insurance plan benefits.

I am a Medicare, Medicaid, or Tri-Care Beneficiary:

  • Freestanding Emergency Centers are a new concept to the American health care system. Due to the newness of these types of facilities, CMS (The Center for Medicare and Medicaid Services and Tricare) does not recognize Freestanding Emergency Centers as potential providers of health care. Therefore, we are prohibited from billing CMS for our services by Federal Law. This is not our choice. We recommend that you contact your Congressman and inform them that you would like to be able to have your Emergency Care covered when you visit freestanding emergency facilities like ours.
  • If you do not have an Emergency Medical Condition, our physicians will explain that to you and explain your alternative options for care.
  • If you are found to have an Emergency Medical Condition, we will treat you regardless of your Medicare, Medicaid, or Tricare status. We will not bill for these services.

I do NOT have insurance:

  • Our Emergency Physicians will evaluate you on arrival and determine if you have an “Emergency Medical Condition”.
  • If you do not have an “Emergency Medical Condition”, our physicians will share alternative options for care with you. If you choose to stay, our registration staff will inform you of the cost of your visit should you choose to stay to complete your care. If you choose to stay and not seek care at the recommended alternative sites, we will collect any balance you may owe prior to the completion of treatment. After you pay this balance, you will not receive any further bills.
  • If you have an Emergency Medical Condition, we will evaluate this to the fullest extent. You will be responsible for all charges incurred during your visit. We do offer a discounted rate for patients that choose to pay out of pocket. You may request a payment plan with our billing company if you are unable to pay your bill.