BILLING & INSURANCE FAQS
We are here to help!
Billing can be confusing and insurance companies make it even harder to understand your benefits. That’s why we have brought our billing in-house, so we can be here to breakdown and answer any questions you may have before or after your visit.
Questions about your bill or insurance coverage? Let us help!
With all the different medical care options out there questions will certainly arise now and then and the insurance companies don't always make understanding your benefits an easy task. We have complied a list of frequently asked questions and answers to help clarify some of the most important patient issues we encounter. If you have any specific questions, please contact us and we will be happy to assist in any way possible.
Does Full Spectrum accept my insurance?
Full Spectrum Emergency Room accepts most commercial health insurance policies including Humana, United Healthcare, CIGNA, AETNA, Blue Cross Blue Shield, OSCAR, and more. As a free-standing Emergency Room, we are not recognized by Medicaid, Medicare, or TRICARE.
Full Spectrum Urgent Care is In-Network with Tricare, Medicaid, Medicare, and most commercial insurance providers.
We also offer transparent self-pay options for our uninsured patients.
Is Full Spectrum In-Network with my insurance provider?
Emergency Room: In accordance with Texas Department of Insurance Code, Section 1301.155 on Emergency Care, Emergency care MUST be covered as “In-Network” and apply to your in-Network benefits, even if the Emergency Room is out-of-network. This law was created to prevent the loss of precious time in an emergent situation so patients do not have to search for an “in-network” provider when facing loss of life or limb. So by law, your treatment for an emergent condition by the “prudent layperson” standard must be reimbursed by your insurance company at in-network rates. Our in-house team of billing professionals are dedicated to helping our patients navigate this process to ensure correct reimbursement.
Urgent Care: Our urgent care is currently in-network with Tricare, Medicaid, Medicare and most commercial insurance providers. Your urgent care deductible would apply to your visit when in-network. If your insurance company is not in-network, we have transparent self-pay options and flexible payment arrangements available.
I received an Explanation of Benefits (EOB) from my insurance company, will I have to pay this amount?
No, it is very important to note that these are NOT bills and do not indicate the amount you owe. An Explanation of Benefits (EOB) will always be sent by your insurance company and will show the benefits they have agreed to pay out based on your specific plan and what they feel you owe. These amounts include what was applied to your remaining deductible (if any) or your co-insurance (if any). You may receive separate EOBs for the facility and one for the physician.
If you have questions upon receiving your EOB, we are here to help. Our dedicated team of in-house billing professionals can check the status of your claim to ensure it has been processed correctly. Insurance claims processes can take time and appeals may be made to negotiate reimbursement in cases where insurance companies are not initially covering certain procedures or costs that should qualify.
Is your facility more expensive than a traditional emergency room?
Due to our ability to treat and bill for urgent care or emergency issues our prices are typically much lower for similar conditions treated through hospital ERs. This is because a hospital will bill full emergency room pricing for urgent care conditions, whereas, you will only be billed for the level of service you need at our facility (urgent care billing available during normal urgent care hours 9am-9pm).
If being seen in the emergency room, our costs are the same or less than many of the other Emergency Rooms in our area.
How much will I have to pay?
If you have insurance coverage, you will pay your Emergency Room or Urgent Care co-pay (depending on which one treats you).
Once your insurance claim has been processed, you may incur additional out-of-pocket expenses based upon the coverage amounts of your insurance policy. For example, if your policy has a deductible that has not been met or your co-insurance does not cover certain procedures you may be responsible for those amounts.
If you are uninsured or underinsured, we have competitive self-pay rates and flexible payment arrangements available for all who are in need.
What happens if insurance denies my claim?
Emergency Room: In accordance with both Federal and Texas laws, if you feel you are experiencing a true emergent condition (prudent layperson standard) and go to any emergency department for treatment your insurance company is required to pay for your care at in-network rate, even if the facility is out-of-network. If your insurance company is refusing payment for your visit, you have the ability to file a grievance with the Texas Department of Insurance. You can find more information about this process at www.tdi.state.tx.us. Our billing team can also assist in filing an appeal with your insurance company on your behalf upon request.
Urgent Care: If we are in-network with your insurance provider and they are refusing coverage please contact us and we will be happy to assist you.
Why did I receive two bills for my emergency room visit?
You will receive one bill from the facility for any emergency room testing or procedural charges.
The second bill is for the professional emergency physician charges and will be billed under PVD Medical Associates. Emergency physicians may not be in-network with your insurance provider.
If you have questions concerning either of these bills please do not hesitate to contact us as billing amounts are different for each patient based on their treatment.
When making payments online, why do I need to make 2 separate payments?
These bills are separate charges, one for the facility and one for the physician that treats you, and must (by law) be proceeded individually to be applied properly to your account. If you have any problems with our online portal please contact our billing department and we will be happy to walk you through the process or take your payment over the phone.
What if I do not have insurance coverage?
If you do not have insurance, don’t worry, we can still help you. We offer extremely competitive self-pay options in accordance with our company pillars to help ensure everyone can afford quality care. Our experienced and compassionate billing team will be happy to work with you one-on-one to arrange a payment plan that fits your needs.
Notice of Emergency Room Billing Practices
In accordance with Texas SB 425 Full Spectrum Emergency Room is required to post the following in regards to billing practices in freestanding emergency departments:
Still have questions?