How Oversight of Insurance Companies can prevent Surprise Medical Bills

How Oversight of Insurance Companies can prevent Surprise Medical Bills

Surprise medical bills are one of the biggest problems that both patients and the physicians agree on. It is frustrating when you get an unexpected medical bill that will cost you up to thousands of dollars, yet you have health insurance. The surprise medical bills are usually a product of the doings of insurance companies. It is part of the business strategy insurance companies providing health insurance use to make them look more valuable.

A patient will purchase a health insurance package with the hope that it will help them pay for their medical care. But for insurance companies, it is a business. So what they do is that they create a sufficiently and irresistibly attractive plan, enroll policyholders then work around to ensure that the biggest chunk of the cash they receive stays with them instead of going to health care for the patients. Additionally, they will advertise and recommend specific physicians and medical facilities just to save more money. The end result is that the insurance companies end up benefiting while the patients are left having to bear the costs of their medical bills.

To get the burden of such bills off the back of patients, Bellaire ER advocates for the idea of oversight of insurance companies. This will help regulate the policies and actions of health insurance service providers to the benefit the patients. Most of the states, including Texas, have laws that require insurers to cater for the costs of non-contracted emergency health care and at the normal rates. The problem comes when you look at the guidelines. The guidelines that govern this law are not uniform, providing room to the insurance companies to determine their own rates. That is why you will find a good number of insurance companies having a payments percentage that is way lower than what the law stipulates. The result is the burden of surprise medical bills being created as the patients end up not receiving the full benefits they ought to receive from their health insurance provider.

Freestanding emergency rooms have been a popular target for health insurance companies. The model of freestanding emergency rooms is quite an innovative one and provides better access to emergency care for patients more effectively and efficiently. But they have been accused of misleading patients and lacking transparency; as per the narrative that insurance companies have. They use this as their basis for processing freestanding emergency center claims. As per the law in Texas, FECs are recognized as essential and are supposed to be processed at the same level as in-network benefit or the normal customary level. However, insurance providers use their “lack of transparency” excuse and the lack of clear guidelines in the law to charge out-of-network rates for freestanding emergency center claims. They end up denying the patient’s coverage access yet they are paying their insurance rates. The result is higher patient responsibility in the form of the surprise bills.

In a move deemed as a step towards the right direction for Texas, the Texas Association of Freestanding Emergency Centers passed a resolution that calls for the Texas Department of Insurance and the Texas Legislative arm to increase and improve data collection with regards to health insurance payment. With this data, it will be much easier for both the patients and the insurance providers to be certain as to what constitutes the customary reimbursement for Texas emergency room procedures. This is part of the efforts that are being made to improve the oversight and the transparency of health insurance companies and the health insurance industry in general.

Data from the Texas Department of Insurance clearly shows that there has been systematic attempts by a good number of insurance companies to slash the payments slated for freestanding emergency centers and have the costs channeled to their patients instead. In fact, some of these insurance companies go as far as keeping the freestanding emergency centers in the out-of-network category intentionally just to ensure that they pay the least amount possible in healthcare claims. This is a chronic practice that can only be stopped with increased oversight of these health insurance service providers to ensure that they are fair to their customers.

This behavior is becoming increasingly rampant and more people are not realizing the benefits of having a health insurance cover. To turn the tables in favor of the patients and against the “greedy” profit approach that insurance companies are employing, the legislative arm of the Texas Government should make it a priority to establish the appropriate laws and clear guidelines to regulate health insurance companies. They should come up with clear standards that are easily enforceable for reimbursements rates that can hold health plans accountable. The main goal is ensuring that all citizens get easy, affordable and reliable access to quality health care. A clear oversight of insurance companies will go a long way in ensuring the realization of this goal.

Are Freestanding Emergency Centers required to treat all patients?

Are Freestanding Emergency Centers required to treat all patients?

Freestanding emergency centers are relatively a new concept that is becoming popular in Texas. However, the industry of FECs has faced various problems and misconceptions. One of the most commonly asked questions is whether the FECs are required to treat all patients. The answer to this question varies by state and by the type of FEC. Bellaire ER has chosen to give an in-depth answer to this issue.

Freestanding emergency centers

FECs are always open, and they are designed to handle emergency health cases such as heart attacks, severe burns and open fractures. They are equipped similar to a hospital emergency center, but they are not located in hospitals. There are mainly two types of FECs.

Hospital owned FEC
A hospital owned freestanding emergency center serves as an outpatient extension of the hospital. The FEC operates the same way as an emergency department located in a hospital. This means that patients get the care accorded at a hospital emergency department including access to emergency specialists and nurses. The FECs are also well equipped with full range laboratories and a broad spectrum of imaging devices. The FEC is part of the hospital, and hence the physicians working here are part of the hospital staff.
These facilities also accept Medicaid and Medicare as they are recognized by the Centers for Medicare and Medicaid Services. If the parent hospital is in-network for a certain health insurance plan, the FEC is also considered to be in-network.

Since these emergency centers are hospital owned, they have to comply with the federal Emergency Medical Treatment and Labor Act (EMTALA). The act mandates the FEC to screen and stabilize any patient who comes into the emergency room with an emergency. People with true emergencies are screened and treated first before they can delve into questions of payment.

However, if after the screening your case is found to be a non-emergency or if you come into the hospital with a non-emergency case, the FEC may turn you away if you don’t have the ability to pay. This is for the FECs that are owned by private hospitals. However, if the facility is a public hospital, you cannot be denied care in any condition whether you can pay or not.

Independently owned FEC
These facilities are independently owned with no hospital affiliations. The independent FECs might have arrangements with local hospitals for transfer of patients after stabilization.

These FECs also don’t accept Medicare or Medicaid since they are not recognized by the Centers for Medicare and Medicaid Services.

The independent FECs have the same equipment and staffing as the hospital owned FECs and they offer the same services as the hospital based emergency rooms.

Independent FECs are not bound by EMTALA or other federal regulations regarding emergency centers. This means that the independent FECs can deny care to a patient even in times of an emergency if they don’t have the ability to pay.

Some states such as Texas have created rules that are similar to the federal EMTALA. In Texas, an independently owned FEC is required to screen and stabilize a patient who is in an emergency situation before they can discuss payment options.

The FECs also treat non-emergency cases, but they can turn a patient away if his/her case is not an emergency and the patient doesn’t have the ability to pay.

Following this analysis, it is clear that FECs are equipped to handle a broad spectrum of illnesses and injuries and although they are meant for emergency cases, you can also get treated for non-emergency cases. The FECs are not required to treat all patients. However, in a place like Texas, all FECs are required to treat any patients with emergency cases even if the patient has no ability to pay for the treatment.

The fact that you can get treatment from a freestanding emergency center or a hospital based emergency department doesn’t always mean that you should. When you have a case of a minor injury, it is better to visit a primary care physician or an urgent care center before you consider going to a freestanding medical center. This is because the FECs charge additional facility fees so that they can effectively manage their many facilities. Going to an FEC for a non-emergency case might cause overcrowding and strain the available resources.

You can visit an independently owned FEC if you are looking for fast and quality healthcare, and you are willing to pay the high cost. These FECs usually have low wait times, and you can be seen by a doctor as soon as you walk in.

Bellaire ER is a freestanding emergency center that offers quality service to its patients. Our facilities are equipped to handle all types of emergencies, and we operate according to the state and federal laws. If you are in an emergency situation near our facilities, you should get there as fast as you can to get medical help.

Demystifying Board-Certified Physicians

When looking for the right emergency room for you and your family, you always want an emergency room operated with a physician with the right qualifications and is board-certified. This is something that everyone talks about but very few people actually what it means to be board-certified and its significance in the medical world. To help understand the meaning of board certification and its significance in the industry we talked to a board-certified physician who is a head physician at Bellaire Emergency Room. We had a hearty chat with Dr. Mario Quintanilla and he was more than willing to help us understand the significance of board certification and what it means. Here is what Dr. Q had to say;
Board certification
Dr. Q was fast to remind us that even after graduating from medical school, a doctor is not able to practice a particular specialty until he/she completes a residency. Residency means practising medicine in a hospital or in a clinic under the supervision of an attending physician. A physician may choose residency in family medicine, anaesthesiology, reconstructive surgery, dermatology among many other medical disciplines. The residency takes a few years and before one completes it, they are not qualified to practice a particular speciality. After working under the scrutiny of an attending physician and qualifying in the residency, the doctor will then acquire a licence. He/she will then have to be put to test by the American Board of Medical Specialties to ascertain his/her level of mastery in the field. He/she has to prove a certain level of competency by passing the test administered by the board. Only after he/she has passed the test and met his challenge will he/she claim to be certified in the speciality or sub-speciality. Only people who have been put to test by the board and met the set goals are therefore eligible to be called board-certified physicians.
So, now that we know what board certification is, we sought to know its importance from Dr. Q.
Benefits of board certification
Board certification is a sign of competency in the field. It is a sign that a physician understands the basics and fundamentals of a specific area of speciality and has complemented his requirements in the medical field. The tests by the board are time bound and encompass almost every aspect of the specified area of speciality. For one to pass the test therefore, they need to have an understanding of the area properly.
Board certification helps serve as a sieve to get rid of the unqualified medical practitioners posing as physicians. This is important because the rogue individuals who pose as qualified physicians get to be eliminated from the medical industry and only the genuine qualified individuals are given the certification. This is important for the standards of medical services and safety of patients. Nobody wants to trust a rogue physician with his/her life ever. Board certification helps ensure that only the qualified individuals are given the go ahead to treat patients and run medical institutions.
Board certification is a proof of experience in the said area of speciality. As we earlier on mentioned, it is impossible to get certification if you have not worked under the keen eye of an attending physician who will be assessing your performance and understanding in the field. This working under the watchful eye of the physician gives you the experience you will need once you are certified and ready to work on your own. You can therefore trust that every board-certified physician has at-least three years of experience under his belt and can be trusted to deliver every time he is asked to.
It is important to note that not all emergency rooms and hospitals employ board certified physicians. Actually most of the emergency rooms in America are run and operated by assistant physicians who are either board eligible and have not taken the certification test or are just fresh from college and are working under an attending physician. Very few hospitals and emergency rooms are operated by board-certified physicians in America and Bellaire emergency room is one of them.
Here at Bellaire emergency room, we care too much about the standards of treatment to delegate the duties of treating chronic and acute complications to half-baked professionals. This is why we staff only qualified and experienced board-certified physicians who we are convinced are capable of handling any form of complication. Our physicians are massively experienced and have been practising for more than 15 years and have literally seen it all when it comes to treating medical conditions.
Don’t gamble with your life by going to physicians who are not board-certified. Contact Bellaire Emergency room today and join the family where you have all your medical needs taken care of by qualified board-physicians with years of experience in the field.