High ER Bill? Try “High Insurance Bill.” Why Your Insurance Company Isn’t Paying for Your Healthcare.

Why Your Insurance Company Isn’t Paying for Your Healthcare

 

Emergency room co-pays are often higher than standard co-pays, depending on your plan. But they are built to be manageable so that you can go to a 24-hour emergency clinic when you need it. But everyone equates emergency rooms with costs that hurt as much as or more than the injury or illness that brought you there in the first place.

Why the balance bills?

The Texas Association of Freestanding Emergency Centers (TAFEC) is calling foul, saying that the blame isn’t on the ER’s shoulders—it’s the insurance company refusing to pay the bills covered in your plan.

TAFEC advocates for fair regulation and to raise statewide awareness of freestanding emergency centers as a high-quality, accessible, emergency medical care option. To highlight the burden that insurance companies are putting on patients, TAFEC investigated a sample of 417 ER cases that occurred in 2016. Among those ER cases, TAFEC found $457,000 in balance bills sent to patients that the insurance company was responsible to pay. That amounts to an average of $1,096 per visit that patients’ insurances wrongfully charged.

These cases were pulled from thousands of cases reported to the Texas Department of Insurance (TDI) by patients seeking mediation for their ER bills. From 2009-2016, TDI received 3,824 patient-initiated mediation requests.

Patients are receiving balance bills because insurance providers are failing to uphold their responsibilities. Patients—regular people with jobs, families, and dozens of other concerns—are not familiar with the particulars of their insurance policies and so are left paying a bill they never owed.

What can be done?

If you have received a balance bill for an insurance visit, you have the right to submit it to TDI for mediation.

“TDI’s complaint and mediation processes are working, but more needs to be done to stop insurers’ chronic and abusive practices of underpaying valid claims,” says Brad Shields, executive director of TAFEC. “TDI’s data show the tip of an iceberg that TAFEC members have been aware of for some time. Chronic underpayment by insurance companies is rampant and ongoing, and it’s causing out-of-network providers to bill patients whose insurers should be paying.”

To learn more about TAFEC’s analysis, read the article here. If you want to know more about how to fight a balance bill for out-of-network charges or any other charges, visit http://www.tdi.texas.gov/ to find out what options you have.

Emergis ER near you is ready for you

If you ever have a question about your ER bill from Emergis, you can reach out to Brittany Brown, the patient billing facilitator, at the Addison facility—just call 214-363-7447.

If you have any questions, give us a call so that you know exactly what to expect the next time you or your family is in an emergency. We hope you never need us—but when you do, we’re always open.