ST. MICHAEL’S EMERGENCY ROOM TAKES YOUR INSURANCE
We understand that there are a lot of questions about how to pay for your 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 any questions.
St. Michael’s Emergency Rooms are not “in-network” for any insurance provider, but we will accept all private insurance plans at “in-network” rates, including but not limited to Cigna, Blue Cross, United Healthcare, and Aetna, along with more than 200 other plans. Medicare, Medicaid, or Tricare do not allow free-standing ERs to participate in their programs.
What “accepting” these insurance plans means to you: St. Michael’s Emergency Rooms will file the insurance for you. You will not have to do the paperwork. Patients are responsible for co-pays, applicable deductibles, co-insurance, and any out-of-pocket cost per your insurance agreement. Please contact us immediately if you have any questions regarding your explanation of benefits or billing.
YOUR INSURANCE MUST PAY FOR AN ER VISIT WHETHER IT’S “IN NETWORK” OR “OUT OF NETWORK”
It’s the law: Your insurance carrier must pay for your emergency room visit per “in-network rates.” 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 layperson 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 a hospital or other 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?
Health care providers see this all the time, but State law requires insurance companies to cover you for emergency room visits. If your insurance company refuses payment for your ER 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.
If your insurance company does not pay “in-network rates” for services rendered at St. Michael’s ER, feel free to contact our billing department experts for assistance with your insurance company. Remember, we believe regardless of what the insurance company says, if you feel a trip to the ER is necessary, then it’s necessary. We are on your side.
To contact the Texas Department of Insurance by phone or mail:
Texas Department of Insurance
333 Guadalupe, Austin 78701
P.O. Box 149104, Austin 78714
Consumer Help 1-800-252-3439
Report Fraud 1-888-327-881