You have questions. wE have answers.
Thank you for choosing Bayou City ER & Hospital for your emergency medical care. To better serve you, we want to make the billing process simple and transparent. We understand that some patients may find the billing process confusing or overwhelming. We want to help you understand your bill. Your bill may be different from other medical bills you may have received from hospitals or physicians. It’s important to note that Bayou City ER & Hospital is a fully licensed hospital with ER services.
In an effort to protect patients, the federal government issued the Federal No Surprises Act (NSA). The NSA addresses several different points. The most notable point is the NSA serves to prohibit surprise billing. A surprise medical bill is an unexpected bill, often for services received from a healthcare provider or facility, that a patient may not have known was out-of-network with their insurance until a bill is received. Simply stated, an out-of-network provider cannot send a bill to a patient for any amount outside of their yearly in-network deductible and co-insurance. This does not apply to amounts paid directly to patients by their insurance provider for services rendered rather than paid to the provider. In those cases, a patient may receive a bill for full charges until the insurance payment amount is provided or paid over to the appropriate facility by the patient.
The Federal No Surprises Act was issued after lawmakers passed a law to base emergency services payments on local median in-network rates, also known as QPAs, instead of usual and customary rates. The law enacted a system where insurers and providers negotiate the correct amount to be paid. Once in agreement, the bill can be settled through an independent dispute resolution process. Insurers must now disclose how they come to the QPA-median in-network price and if they down-coded the claim for any reason.
The hospital is out-of-network for all benefit plans.
Hospital Notice Required by HB 2041
The facility is licensed as a Hospital under the provisions of Chapter 241, Health and Safety Code, and the Hospital Licensing Rules.
The facility charges rates comparable to other hospitals and may charge a facility fee for emergency room services.
The facility or physician providing services at the facility may be out-of-network with the patient’s health plan.
A physician(s) providing medical care at the facility may bill separately from the facility for the medical care provided to a patient.
The hospital is out-of-network for all benefit plans.
El hospital está fuera de la red para todos los planes de beneficios.
Aviso hospitalario requerido por HB 2041
La instalación tiene licencia como Hospital bajo las disposiciones del Capítulo 241, el Código de Salud y Seguridad, y las Reglas de Licencias Hospitalarias.
La instalación cobra tarifas comparables a otros hospitales y puede cobrar una tarifa de instalación por los servicios de sala de emergencias.
El centro o médico que presta servicios en el centro puede estar fuera de la red con el plan de salud del paciente.
Un médico que proporciona atención médica en el centro puede facturar por separado del centro para la atención médica proporcionada a un paciente.
El hospital está fuera de la red para todos los planes de beneficios.
Learn more about the No Surprises Act at CMS.gov/nosurprises, or call the Help Desk at 1-800-985-3059 for more information.
If you have any questions concerning your bill, please contact our Billing Department at 713-357-2535.
We accept all commercial insurance and cash, checks, and all major credit cards as forms of payment. At the time of your visit, your ER co-pay will be collected. Then, your insurance company will be sent two different claims: the facility bill and the physician bill.
If you have any questions concerning your bill, please contact our Billing Department at 713-357-2535.
Bayou City ER & Hospital does honors all in-network deductibles and accepts all commercial insurance. We do not accept any government-funded insurance plans, like Medicaid or Medicare. If you use health insurance during your visit, you will receive an EOB (explanation of benefits) from your insurance company in the mail. It is important to note that the EOB is not a bill.
Workers’ compensation is a state-funded insurance program that gives covered employees income and medical benefits if they are injured at work. Texas employers may choose to provide their employees with this coverage and typically inform you whether or not you’re covered.
For all cases deemed emergent, Texas state law requires your insurance company to pay for your emergency care, even if the emergency room is classified as out-of-network. The state of Texas empowers patients to use a standard called the Prudent Layperson Standard when determining what constitutes as an emergency.
If your insurance provider is refusing to reimburse you for your emergency room visit, you can file a complaint with the Texas Department of Insurance (TlDI). For more information about this process and the Texas Department of Insurance visit http://www.tdi.state.tx.us.
Emergency Room Billing Information Simplified
We understand that medical bills can be confusing, especially during an emergency. Below is a simple explanation of how Emergency Room billing works and what you may expect after your visit.
1. You Receive Care
- When you visit the Emergency Room, our medical team evaluates and treats your condition.
2. We Bill Your Insurance
- Our billing team sends two separate claims to your health insurance company for the services you received. One for the facility services and one for physician services.
3. Insurance Reviews the Claim
- Your insurance provider reviews the services and determines what they will pay based on your plan’s benefits.
4. Explanation of Benefits (EOB)
- Your insurance company will send you an Explanation of Benefits (EOB). This is not a bill.
- It shows:
- What services were billed
- What your insurance paid
- What amount may be your responsibility, such as Copay, Coinsurance and Deductible.
5. You May Receive a Billing Statement
- If there is a patient balance applied by your insurance such as Copay, Coinsurance, and Deductible, you will receive a statement showing the amount owed. Please be advised, this is not a balance bill.
Emergency Room care often involves multiple providers. Because of this, you may receive separate bills from: The hospital or facility & the emergency room physician.
Depending on your insurance plan, you may have some out-of-pocket costs.
- Copay: A fixed amount you pay for an Emergency Room visit, typically collected at the time of service in the Hospital.
- Deductible: The amount you must pay each year before your insurance begins paying for certain services.
- Coinsurance: A percentage of the cost you may be responsible for after your deductible is met.
- Out-of-Pocket Maximum: The most you will pay during your plan year for covered services.
Under the No Surprises Act, patients are protected from surprise medical bills for emergency services.
This means:
- You cannot be charged more than your in-network cost-sharing amount for emergent care.
- You will not be balanced billed for emergency services.
- Providers cannot bill you for the difference between what your insurance pays/allows and the total charge.
You are only responsible for your Emergency Room copay, deductible, or coinsurance according to your insurance benefit plan.
If you have questions about your Emergency Room bill, our billing team is happy to help explain your statement and review your account.
Please contact our billing office for assistance at (713) 357-2535 Monday – Friday 07:30 am – 5:30 pm CST.
