Emergency Room Guidelines
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Emergency Room Guidelines
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/.
- Senate Bill 425
- Texas Emergency Care Center is an emergency room.
- Texas Emergency Care Center charges rates comparable to a Hospital emergency department, including a facility fee.
- The physician may bill separately from the facility.
- Texas Emergency Care Center and facility-based physicians is not a participating provider in an individual’s health plan network.
For more information about Senate Bill 425, click here.
No Balanced Billing
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/.