Insurance Information | Quality Care ER
I thought my son had broken his arm. I knew that the hospital ER would take several hours and I had heard good things about Quality Care so I decided to try them out. We had no wait at all! They took us back immediately and as soon as we were in the room the nurse (Chastin), radiology tech (Jessie), and Dr. Marino came in and started assessing. We were in and out in approximately an hour and a half even with X-rays and splinting. Everyone was extremely kind, respectful, and professional and their great attitude help my son stay calm. Overall it was the best possible experience someone could have in the ER and if we ever need an ER again (which is quite possible with boys), we will return to Quality Care ER! Caden

HOW CAN WE 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 903-900-5888 or by email at clawson@qualitycare-er.com 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 FAQS:
For any billing or insurance questions you may have, please contact our billing department at 903-900-5888 or by email clawson@qualitycare-er.com. We look forward to serving you.

Do you accept my insurance?
We welcome 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 upon 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 upon 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.state.tx.us 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 Emergency Center 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 903-900-5888 at any time to discuss your specific care needs and the potential associated charges.

In addition, as required by the Texas House Bill 2041, passed by the Texas Legislature during the 86th Regular Session, our facility has provided a complete list of charges for all services and items provided by our facility.

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.

Texas House Bill 2041, passed by the Texas Legislature during the 86th Regular Session, requires all free-standing emergency centers to post the following notice:

  • The facility is a freestanding emergency medical care facility
  • The facility charges rates comparable to a hospital emergency room and may charge a facility fee
  • A facility or a physician providing medical care at the facility may be an out-of-network provider for the patient’s health benefit plan provider network
  • A physician providing medical care at the facility may bill separately from the facility for the medical care provided to a patient
  • The facility is an out-of-network provider for all health benefit plans

 

Call Quality Care ER

(903) 900-5888