We are open year round 24/7 to assist with any emergencies that come up in life. We bill most major insurance providers including TriCare and we are in network with Cigna. Medicaid and Medicare does not recognize Physician owned Emergency Rooms and at this time they do not accept our patient billing.
Understanding your explanation of benefits (EOB) towards ER policies will help you understand what to expect when walking into My Emergency Room 24/7. After completing necessary forms to verify insurance, and your medical screening has been completed, our billing specialist will be able to compile a treatment plan cost analysis. At this point a patient can ask what the treatment plan will be and discuss the cost if needed. If the patient chooses to proceed with the treatment plan and can make co-pay fee it will be collected then. The patients insurance company will be billed the remainder of the treatment plan.
If you have any additional questions about insurance and billing, don’t hesitate to contact us.
What can I expect?
Two separate claims will be submitted to your insurance company; one claim for the facility (My Emergency Room 24/7) and one claim for physician services STC Emergency Physicians PA. Your insurance company will not be charged separately for radiology, pathology, or cardiology over reads as with hospital-based ER’s. These charges are included on your facility bill. Should you have any financial responsibility after your insurance company processes your claims, you will receive two statements one for the amount you owe for the facility charges and the other for the amount you owe for the physician charges.
Why am I receiving bill(s) when I already paid my co-pay or co-insurance?
At the time of service, your ER co-pay and/or a portion of your deductible amount was collected. As a courtesy, we will file claims to your insurance carrier for your emergency room benefits. The balance due represents your remaining deductible, co-insurance, and, in some cases other non-covered services.
What are non-covered services?
Non-covered services are diagnostics and treatment services that are not covered under your insurance plan. In most instances, these denials of coverage are automatically appealed back to the insurance company for payment. You will receive statements only after the denial of an appeal or if the insurance company is unwilling to negotiate payment for allowed services.
What is a deductible?
A deductible is the amount you must pay out of pocket for expenses before your insurance company will begin to cover your medical bills. Typically, your deductible starts over at the beginning of the calendar year and each family member must meet their own deductible.
How can I help?
Be familiar with your insurance benefits. Take the time to review your insurance policy. Find out if you have a deductible, co-insurance or anything else that may be your responsibility. This knowledge will help you to make educated decisions when seeking medical care.
What is co-insurance?
Co-insurance is the amount of out-of-pocket you must pay for services rendered. For example, if your plan only covers 80% of the allowed amounts for services then you must pay the other 20%.