Insurance Information

How Can Quality Care ER Help You?

We understand that dealing with healthcare bills and your insurance company can be confusing and frustrating. We are always here to help you learn more about the process as well as answer any questions you may have from insurance claims to questions about your bill.

Please contact our billing department at (903) 417-0886 (Paris), or (903) 307-0544 (Greenville). You can also fill out our online form with any questions you may have. We truly look forward to serving you.

What Can You Expect Regarding Cost?

Because of lower overhead, our emergency room prices are often less than those of a traditional hospital-based ER—even though we have the same capabilities, equipment, and experienced doctors and staff.

Using Insurance

We understand that dealing with a health insurance claim is often a frustrating experience. Understanding the process of medical billing and the details of your specific policy—individual and family benefits, co-pays, deductibles, and co-insurance—can be rather confusing. Knowing the details of your specific policy can help you make informed decisions regarding your medical care.

Our friendly staff will gladly answer any questions you may have, clarify what you actually owe, and will work with you each step of the way to make the experience as easy and convenient as possible.

Other Payment Methods

For patients who do not have insurance or do not want to use it, we offer a substantial discount when payment is made in full at the time of service. Quality Care ER accepts all major credit cards and can also arrange scheduled payment plans or third party financing options for qualified patients.

Billing & Insurance FAQ

For any billing or insurance questions you may have, please contact our billing department at (903) 417-0886. We look forward to serving you.

Do you accept my insurance?

We will process all major private insurance such as Aetna, Blue Cross/Blue Shield, Humana, Cigna, United Healthcare, and others. Unfortunately, at this time we do not accept Medicare, Medicaid, or TriCare.

What will I pay if I use my insurance?

As with any emergency room, urgent care clinic, or doctor’s office, we collect a copayment (copay) at the time of service, which varies in cost based on your specific policy and whether you received treatment in the emergency room.

After your insurance company has processed your claim, any additional out-of-pocket expenses you may incur are based on the specific terms of the policy you purchased. For example, you may be required to pay a deductible or co-insurance they deem is your responsibility. Knowing the details of your specific policy can help you make informed decisions regarding your medical care.

How are claims processed?

On your behalf, our billing specialists will submit your claim to your insurance company. After your visit you will receive an “Explanation of Benefits (EOB)” detailing the benefits paid out based on your specific plan and what they claim you owe—including amounts applied to your remaining deductible or any co-insurance. You may even receive more than one EOB, such as one for the facility and one for the physician. It is important to know these EOBs are NOT bills, and you may not actually owe what is indicated.

Please call us upon receiving your EOB, so we can check the status of your claim and ensure it has been processed correctly. The claims process can take time, as appeals may be made to negotiate reimbursement. Our friendly staff will gladly answer any questions you may have, clarify what you actually owe, and will work with you each step of the way to make the experience as easy and convenient as possible.

What if my insurance company denies my claim?

If your insurance company refuses payment for your visit, you can file a grievance with the Texas Department of Insurance. Please visit www.tdi.texas.gov to learn more. In addition, our billing specialists will file an appeal with your insurance company on your behalf and will handle the entire appeals process for you.

I received an Explanation of Benefits (EOB) after my visit. Is this my bill?

After your visit, your insurance company will mail you an “Explanation of Benefits (EOB)” detailing the benefits paid out based on your specific plan and what they claim you owe—including amounts applied to your remaining deductible or any co-insurance. You may even receive more than one EOB, such as one for the facility and one for the physician. It is important to know these EOBs are NOT bills, and you may not actually owe what is indicated.

Please call us upon receiving your EOB, so we can check the status of your claim and ensure it has been processed correctly. The claims process can take time, as appeals may be made to negotiate reimbursement.

How do I pay if I don’t have insurance?

For patients who do not have insurance or do not want to use it, we offer a substantial discount when payment is made in full at the time of service. All major credit cards, such as MasterCard, Visa, American Express, and Discover are accepted.

Are freestanding emergency rooms more expensive than hospital-based ERs?

Charges for care in both facilities are essentially the same. Senate Bill 425 relates to healthcare and fees charged by freestanding emergency centers. Quality Care ER is a freestanding emergency medical care facilities that charge rates comparable to hospital ERs and may charge separate facility fees. Patients may also be treated by physicians who are out of network and/or may be billed separately by the physician providing medical care. Quality Care ER complies fully with this law.

What is a facility fee and how is it different from a professional fee?

A facility fee is a service fee charged by a healthcare facility to cover the cost of operating and staffing the emergency room and hospital 24/7/365. These overhead costs allow to provide our services to include but are not limited to utilities, supplies, providing and maintaining advanced diagnostic equipment, employing qualified nursing personnel and support medical and administrative staff, as well as the facility itself.

A professional fee is the cost for services provided by the physician.

Calculating Your Bill

Quality Care ER is committed to helping you understand and prepare for potential out-of-pocket costs related to medical services you or a loved one may receive at our hospital, and we have resources available to assist you. Please contact us at (903) 417-0886 at any time to discuss your specific care needs and the potential associated charges.

The amount listed is not necessarily reflective of your actual financial responsibility. The amount collected by our hospital can be less than the amount on this list for a number of reasons, including discounts negotiated with third-party payers like Medicare, Medicaid, and commercial insurance companies as well as patient-specific discounts based upon financial need and other considerations. We recommend that all patients contact their insurer or our Patient Advocate at 903-900-5888 to discuss their individual situations and determine the potential out-of-pocket costs of their care.

Insurance Information

Texas Senate Bill 425

Senate Bill 425, passed by the Texas Legislature during the 84th Regular Session, requires all FECs to post notice of the following:

• This is a Freestanding Emergency Medical Care Facility
• This facility charges rates comparable to a hospital Emergency Room and may charge a facility fee
• This facility or physician providing medical care at this facility may not be a participating provider in your Health Benefit Plan provider network
• A physician providing medical care at this facility may bill separately from the facility for the medical care provided to you

Texas House Bill 3276

• If we are not in-network with your particular health plan, Federal law requires insurance companies to process your ER visit at the in-network benefit level.
• We are not yet recognized by Medicaid. If you would like to assist us in being able to accept these insurance plans, please contact your legislators.

Texas House Bill 2041

House Bill 2041, passed by the Texas Legislature during the 86th Regular Session, requires all FECs to post notice of the following:

• This facility is a Freestanding Emergency Medical Care Facility.
• This facility is an out-of-network provider for all health benefit plans.
• This facility charges rates comparable to a hospital Emergency Room and may charge a facility fee.
• The facility or physician providing medical care at this facility may be an out of network provider for the patient health benefit plan provider network.
• A physician providing medical care at this facility may bill separately from the facility for the medical care provided to the patient.
• In addition, as required by the Texas House Bill 2041, our facility has provided a complete list of charges for all services and items provided by our facility.
• You can view the fee schedule here.
• Questions concerns regarding this matter may be directed to the administration of this facility at 903-417-0886

Este centro es un centro de atención médica de emergencia independiente. Este centro es un proveedor fuera de la red para todos los planes de beneficios de salud. Esta instalación cobra tarifas comparables a una sala de emergencias de hospital y puede cobrar una tarifa de centro por tratamiento médico; Un centro o un médico que proporciona atención médica en el centro puede ser un proveedor fuera de la red de proveedores del plan de beneficios de salud del paciente; El médico que proporciona atención médica en el centro puede facturar por separado del centro por la atención médica proporcionada a un paciente; Esta instalación es un proveedor fuera de la red para algunos planes de beneficios de salud.

Your Rights and Protections Against Surprise Medical Bills

When you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing.

What is “balance billing” (sometimes called “surprise billing”)?

When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, such as a copayment, coinsurance, and/or a deductible. You may have other costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network. “Out-of-network” describes providers and facilities that haven’t signed a contract with your health plan. Out-of-network providers may be permitted to bill you for the difference between what your plan agreed to pay, and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your annual out-of-pocket limit. “Surprise billing” is an unexpected balance bill. This can happen when you cannot control who is involved in your care—like when you have an emergency or when you schedule a visit at an in- network facility but are unexpectedly treated by an out-of-network provider.

You are protected from balance billing for:

Emergency services

If you have an emergency medical condition and get emergency services from an out-of- network provider or facility, the most the provider or facility may bill you is your plan’s in- network cost-sharing amount (such as copayments and coinsurance). You can’t be balance billed for these emergency services. This includes services you may get after you’re in stable condition unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services.

In accordance with the No Surprise Act requirement the beneficiary or guarantor receiving services at Quality Care ER will not be balanced billed for any amounts which are considered not allowable by your insurance company. The guarantor or beneficiary will only be billed for co-pays, deductibles and co-insurance amounts in accordance with the insurance plan.

Certain services at an in-network hospital or ambulatory surgical center

When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers may bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers can’t balance you and may not ask you to give up your protections not to be balance billed. If you get other services at these in-network facilities, out-of-network providers cannot balance bill you, unless you give written consent and give up your protections.

You’re never required to give up your protections from balance billing. You also aren’t required to get care out-of-network. You can choose a provider or facility in your plan’s network.

This facility is in compliance with HB2041. This information is provided to you in a separate disclosure. This facility does not balance bill for any out-of-network services.

When balance billing isn’t allowed, you also have the following protections:

You are only responsible for paying your share of the cost (like the copayments, coinsurance, and deductibles that you would pay if the provider or facility was in-network). Your health plan will pay out-of-network providers and facilities directly. Your health plan generally must:

• Cover emergency services without requiring you to get approval for services in advance (prior authorization).
• Cover emergency services by out-of-network providers.
• Base what you owe the provider or facility (cost-sharing) on what it would pay an in-network provider or facility and show that amount in your explanation of benefits.
• Count any amount you pay for emergency services or out-of-network services toward your deductible and out-of-pocket limit.

If you believe you’ve been wrongly billed, you may contact Texas Health and Human Services at (800) 458-9848 or email hfc.complaints@hhs.texas.gov

Visit https://www.cms.gov/nosurprises for more information about your rights under federal law.

For more information about your rights under Texas state laws visit:

https://www.tdi.texas.gov/tips/texas-protects-consumers-from-surprise-medical-bills.html

Usted Derechos y Protecciones Contra Sorpresa Médico Cuentas

Cuando recibe atención de emergencia o recibe tratamiento de un proveedor fuera de la red en un hospital o centro quirúrgico ambulatorio dentro de la red, está protegido dela facturación sorpresa o la facturación del saldo.

¿Qué es la "facturación de saldo" (a veces llamada "facturación sorpresa")?

Cuando vea a un médico u otro proveedor de atención médica, es posible que deba ciertos costos de su bolsillo, como un copago, un coseguro y / o un deducible. Es posible que tenga otros costos o tenga que pagar la factura completa si ve a un proveedor o visita un centro de atención médica que no está en la red de su plan de salud. "Fuera de la red" describe a los proveedores e instalaciones que no han firmado un contrato con su plan de salud. Es posible que a los proveedores fuera de la red se les permita facturarle la diferencia entre lo que su plan acordó pagar y el monto total cobrado por un servicio. Esto se llama"facturación desaldo". Es probable que esta cantidad sea mayor que los costos dentro de la red para el mismo servicio y es posible que no cuente para su límite anual de desembolso. La "facturación sorpresa" es una facturade saldo inesperada. Esto puede suceder cuando no puede controlar quién está involucrado en su atención, como cuando tiene una emergencia o cuando programa una visita en un centro dentro de la red, pero es tratado inesperadamente por un proveedor fuera de la red.

Usted está protegido de la facturación del saldo por:

Servicios de emergencia

Si tiene una afección médica de emergencia y recibe servicios de emergencia de un proveedor o centro fuera de la red, lo máximo que el proveedor o centro puede facturarle es el monto de costos compartidos dentro de la red de su plan (como copagos y coseguros). No se le puede facturar el saldo de estos servicios de emergencia. Esto incluye los servicios que puede obtener después de estar en condición estable a menos que dé su consentimiento por escrito y renuncie a sus protecciones para que no se le facturen de manera equilibrada por estos servicios posteriores a la estabilización.

De acuerdo con el requisito de la Ley De No Sorpresa, el beneficiario o garante que reciba servicios en Excel ER nose le facturará de manera equilibrada por ningún monto que su compañía de seguros considere no permitido. Al garante o beneficiario solo se le facturarán los copagos, deducibles y montos de coseguro de acuerdo con el plan de seguro.

Ciertos servicios en un hospital o centro quirúrgico ambulatorio dentro de la red

Cuando recibe servicios de un hospital o centro quirúrgico ambulatorio dentro de la red, ciertos proveedores pueden estar fuera de la red. En estos casos, lo máximo que esos proveedores pueden facturarle es el monto de costos compartidos dentro de la red de su plan. Esto se aplica a la medicina de emergencia, anestesia, patología, radiología, laboratorio, neonatología, cirujano asistente, hospitalista o servicios intensivistas. Estos proveedores no pueden equilibrarlo y es posible que no le pidan que renuncie a sus protecciones para que no se les facture el saldo. Si obtiene otros servicios en estas instalaciones dentro de la red, los proveedores fuera de la red no pueden equilibrar la factura, a menos que usted dé su consentimiento por escrito y renuncie a sus protecciones.

Nunca sele pedirá que renuncie a sus protecciones de la facturación del saldo. Tampoco está obligado a recibir atención fuera de la red. Puede elegir un proveedor o instalación en la red de suplan.

Esta instalación cumple con HB2041. Esta información se le proporciona en una divulgación separada. Esta instalación no equilibra la factura de ningún servicio fuera de la red.

Cuando no se permite la facturación de saldo, también tienes las siguientes protecciones:

Usted solo es responsable de pagar su parte del costo (como los copagos, el coseguro y los deducibles que pagaría si el proveedor o la instalación estuviera dentro de la red). Su plan de salud pagará directamente a los proveedores e instalaciones fuera de la red. Su plan de salud generalmente debe:

• Cubra los servicios de emergencia sin necesidad de obtener la aprobación de los servicios por adelantado (autorización previa).
• Cubrir los servicios de emergencia de proveedores fuera de la red.
• Base lo que le debe al proveedor o instalación (costo compartido) en lo que pagaría a un proveedor o instalación dentro de la red y muestre esa cantidad en su explicación de beneficios.
• Cuente cualquier cantidad que pague por servicios de emergencia o servicios fuera de la red para su deducible y límite de desembolso.

Si cree que se le ha facturadoincorrectamente, puede comunicarse con Texas Health and Human Services al (800) 458-9848 o enviar un correo electrónico a hfc.complaints@hhs.texas.gov

Visitehttps://www.cms.gov/nosurprises para obtener más información sobre sus derechos bajo la ley federal.

Fo más información sobre sus derechos bajo las leyes estatales de Texas visite:

https://www.tdi.texas.gov/tips/texas-protects-consumers-from-surprise-medical-bills.html