BILLING & INSURANCE FAQS
We are here to help!
Billing can be confusing and insurance companies make it even harder to understand your benefits. That is 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 compiled 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 and/or In-Network with my insurance provider?
Full Spectrum Emergency Room accepts most commercial health insurance policies including Tricare. However at this time, we do not accept Oscar insurance. Furthermore, Freestanding Emergency Rooms are not recognized by any form of Medicare or Medicaid, therefore we are unable to submit claims.
At this time the Emergency Room and/or physician is not a participating provider in any health benefit plan provider network, HOWEVER… in accordance with Texas Department of Insurance Code, Section 1301.155 on Emergency Care, all emergency care MUST be processed as In-Network by your insurance company, 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, limb or sight. By law, your treatment for an emergent condition under the “prudent layperson” standard must be reimbursed by your insurance company at the policies in-network benefit level. With our “TRANSPARENT” billing practices and our in-house billing team, we will make sure you never get a surprise bill.
Our Urgent Care accepts most commercial health insurance policies including Tricare and Medicare.
NEW*** We are proud be able to serve those that have served us by participating in the VA Mission Act through TriWest Heathcare Alliance.
Our urgent care is currently in-network with Tricare, Medicare, TriWest Healthcare Alliance, and most commercial insurances providers. However at this time we do not accept United Healthcare, any form of Medicaid, or Oscar in our Urgent Care. 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.
How much will I have to pay?
If you have insurance coverage:
The front staff member will explain your Urgent Care benefits, collect your co-pay and an Urgent Care nurse will call you back to be seen. After your insurance claim has been processed (which may take a few weeks), if any portion of the in-network insurance claim is pushed to your deductible or co-insurance, a bill will be processed and sent to you.
You will be given at no cost to you, a Medical Screening Exam (MSE) by one of our Emergency Room Doctors who will explain what services he/she feel you require. After that, one of our staff will explain your insurance benefits and provide you with a “max out of pocket” rate that you may be responsible for after we process your insurance claim. If at that time you choose not to have the recommended services, you will be discharged at no cost to you.
If you decide to stay, and once your insurance claim has been processed (which may take several weeks), you may incur the “max out of pocket” rate you agreed to at time of service, 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 up to the “max out of pocket” rate at time of service minus any co-pay you may have already paid.
If you are uninsured:
Don’t worry, we have “TRANSPARENT” self-pay rates (for both Urgent Care and Emergency Room visits) and flexible payment arrangements.
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. The insurance claim process 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.
What happens if insurance denies my claim?
Emergency Room: Full Spectrum will appeal your claim on your behalf but at some point we may ask you to simply “help” us in communicating with your insurance company. However, you will never be responsible for more than the “max out of pocket” you agreed upon at time of service.
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.
The total between the two bills will equal the “max out of pocket” you agreed to at time of service.
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, insurance and their “max out of pocket” at time of service. If your bill is higher than your “max out of pocket”, simply give us a call for adjustment.
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 and “TRANSPARENT” self-pay options 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?