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 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.
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 an “agreed upon” price 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 additional expense you agreed upon 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 amount you agreed upon 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.
Does Full Spectrum accept my insurance?
Full Spectrum Emergency Room accepts most commercial health insurance policies. However, 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. At this time we do not accept United Healthcare in our Urgent Care.
We are proud to offer “TRANSPARENT” billing so you never receive a surprise bill.
Is Full Spectrum In-Network with my insurance provider?
The facility may not be a participating provider in your health benefit plan provider network, HOWEVER. Texas Department of Insurance Code, Section 1301.155 on Emergency Care requires that insurance companies pay emergency facilities at the insured’s “in-network benefit level” for all services.
Physician(s) providing treatment may not be a participating provider in each patient’s health benefit plan provider network and may bill separately from the facility for medical care provided.
In accordance with Texas Department of Insurance Code, Section 1301.155 on Emergency Care, all Emergency care MUST be processed as “In-Network”, 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.
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.
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.
Is your facility more expensive than a traditional emergency room?
Due to our “TRANSPARENT” pricing and ability to separately treat and bill for Urgent Care or Emergency Care 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 (NOTE: Urgent Care billing only available during normal Urgent Care hours). After hours will be seen and billed at our “TRANSPARENT” Emergency Room pricing.
If being seen in the emergency room, our costs are the same or less than many of the other Emergency Rooms in our area. However, with our “TRANSPARENT” pricing we are still in many cases less expensive.
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, 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 still 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
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.
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 and their agreed upon rate at time of service. If your bill is higher than your agreed upon rate, simply give us a call for adjustment.
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 and “TRANSPARENT” 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?