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Insurance

Sugar Land, TX

We understand that there can be a lot of questions about how to pay for your emergency medical care. It can be stressful, confusing, and one of the major reasons people do not seek medical care. Here are some FAQs about our insurance policies. Contact us if you have questions.

ST. MICHAEL’S EMERGENCY ROOM TAKES YOUR INSURANCE

St. Michael’s Emergency Rooms are not “in network” for any insurance provider, but we accept all private insurance plans including Cigna, Blue Cross, United Healthcare and Aetna. Our emergency clinic also accepts more than 200 other plans. We do not accept Medicare or Tricare. What “accepting” these plans means to you: St. Michael’s Emergency Rooms will file the insurance for you. You will not have to do the paperwork.

YOUR INSURANCE MUST PAY FOR AN ER VISIT WHETHER IT’S “IN NETWORK” OR “OUT OF NETWORK”

It’s the law: you must be reimbursed by your insurance carrier for your emergency room visit. Texas law requires your insurance carrier to pay for your emergency care, whether the emergency room is “in network” or “out of network.” The state of Texas empowers you to use “a prudent lay person standard” in considering what constitutes an emergency. What this means: if you determine that your health or life or that of someone in your care has a medical condition serious enough to go to an emergency room, the most convenient emergency room is the right choice. If a patient determines that waiting hours in an emergency room to be seen by a doctor could compromise their health or life, an emergency room (such as St. Michael’s) which offers a short wait time is the best choice. In other words, you as the patient are empowered to use your best judgment in choosing an emergency care facility, whether it’s “in network” or “out of network” on your insurance plan.

WHAT IF MY INSURANCE CARRIER REFUSES TO PAY?

State law requires patients to be reimbursed for emergency room visits by their insurance carrier. If your insurance company refuses payment for your emergency room visit, you can file a grievance with the Texas Department of Insurance. To learn more about the Texas Department of Insurance, please refer to their website:  http://www.tdi.state.tx.us.

St. Michael’s Emergency Center is a freestanding emergency medical care facility;

St. Michael’s Emergency Center charges rates comparable to a hospital emergency room and may charge a facility fee;

St. Michael’s Emergency Center and/or a physician providing medical care at St. Michael’s Emergency Center may not be a participating provider in the patient’s health benefit plan provider network; and

A physician providing medical care at St. Michael’s Emergency Center may bill separately from St. Michael’s Emergency Center for the medical care provided to the patient.