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What is a co-payment?
A co-payment is a fixed amount the policyholder must pay for a covered health care service. The co-payment is generally required at the time of service, as outlined in the policyholder’s benefit plan that explains covered services. Co-payments (sometimes called “copays”) can vary for different services within the same plan. For example, a co-payment for a primary care physician visit may be $30 per one’s benefit plan, where the co-payment for an emergency room visit may be $150.
What is a deductible?
Generally, a deductible is an annually set amount a policyholder must pay for covered health care services. The plan may include a deductible per patient or for all patients covered by a family policy. With a $2,000 deductible per family, for example, the policyholder will be responsible for payment of the first $2,000 of covered services per that deductible. After meeting the annual deductible as outlined in the insurance benefit plan, the policyholder typically remains responsible for a copayment or coinsurance for covered services.
What is coinsurance?
Generally, coinsurance is the percentage of costs of a covered health care service a policyholder is responsible for. When an insurance company processes a claim and applies any balance to a policyholder’s coinsurance, copayment, or deductible for a covered expense, the policyholder is contractually obligated to pay the remaining portion of the medical bill per their agreement with their health insurance company.
Why am I receiving two bills?
When receiving care in an emergency facility, you will be presented with a minimum of two separate bills – one for the emergency room physician who rendered care and a separate bill for the facility. The physician’s bill covers services provided by a physician, physician’s assistant, or nurse practitioner. The facility bill covers the cost of providing the technicians, equipment, and supplies involved in the performance of your service.
Why didn’t my insurance pay for a covered expense?
When receiving healthcare services, being familiar with your insurance benefit plan is vital to understanding your financial responsibility for any medical services rendered to you or any covered member within your benefit plan. The important items a policyholder needs to be aware of include co-payments, deductibles, and co-insurance. These are amounts that the patient (policyholder) is responsible for as outlined in the insurance company’s benefit plan.
What is the difference between a free standing emergency room and an urgent care?
According to the Texas Association of Freestanding Emergency Centers; “A freestanding emergency center is a facility licensed by the state to provide 24-hour emergency services to patients at the same level as a hospital-based emergency room…” Freestanding ERs are completely separate from critical care hospitals or hospital ERs and may be owned by physicians, hospitals and/or other business interests.
Freestanding Emergency Rooms are required to be open and operating 24/7 with ER physicians readily available. They must provide continual lab and imaging services. They can handle both emergency and non-emergency levels of care. Generally, they are located close enough to hospitals to allow for rapid transport of patients should a higher level of care or admission be required. Unlike urgent care facilities that are not required to dispense medications, freestanding ERs must have a repository for medications that are generally used and needed in a hospital emergency room. The out-of-pocket costs for freestanding ERs will apply in both non-emergency and emergency situations.
An Urgent care is a category of walk-in clinic focused on the delivery of ambulatory care in a dedicated medical facility outside of a traditional emergency room. Urgent care centers primarily treat injuries or illnesses requiring immediate care, but not serious enough to require an emergency room visit or services.
Why won’t your online pay system let me make a payment?
Generally, your problem in using our online payment system is because of mistakes in the way the information is entered. The online payment system requires very specific information. In order to log in to your account to remit a payment online, you must enter the account number exactly how it appears on your statement. This includes the alpha prefix, period, and numbers all together with no spaces. Most errors are related to extra spaces in the account number. Be sure to enter the patient’s date of birth in a mm/dd/yyyy format. Remember to include the zip code that is on file for the patient.
If you require assistance logging in or submitting your payment, we are happy to help. Contact our customer service number that is listed on your statement and a representative will be able to assist you.