What if I Have Questions About my Emergency Room Bills?
After a visit to the ER, you will no doubt get a bill when you leave. However, you may not always be happy with the kind of bill you get. Just like any other service, it is possible that some mistakes will occur during the preparation of your bill. Thus, you should never be afraid to speak up. We at Bellaire ER will explain the ER billing process. We hope that it will help clear up some of the issues you may have. We will also give you a few tips on what to do in case you are unhappy with a bill.
How the billing process works at the ER
Each time you visit the ER, you are always given long forms, which you have to fill in with your health insurance details. The information will then be filed with a copy of the health insurance card. Most people usually leave the process at that; they have no idea what goes on after. In this article, we will try to demystify the billing process for you
What goes on after you provide the information?
After you fill in the information, a health insurance claim is filed with your insurer. A health insurance claim is a bill your insurer gets for medical services, which you received at the ER. The insurance company then agrees to pay this claim base on the services you got. In most cases, there is co-pay, which is a payment you will make from your own pocket. However, the insurer will usually cover the largest chunk of the bill.
Everyone is covered for the ER
If you have insurance, it always comes with insurance cover, no matter how basic your plan might be. In fact, if you live in Texas, the insurer has to cover you, no matter which ER you visit. When you are experiencing a medical emergency, the decision as to whether to visit the ER is up to you. Your insurer is legally required to pay for any out of network costs for your ER visit.
When you are done filing the admission paperwork at the ER, you will be requested to pay the co-pay, which your policy establishes during your visit. You can then ask for the billing options from the billing clerk for the ER you visit. At some emergency rooms, they honor in-network billing even when they are not part of the insurer’s network. They know that these details can help to cut down the total claim made by the insurer.
The explanation of benefits is not bills
As soon as you leave the ER, the billing process kicks off. You will soon after get an explanation of benefits or EOB in your mail. This document will list the services, which you received when you were in the ER, and their individual costs.
However, you have to keep in mind that the EOB is not the bill. The ER uses it to generate a claim for your insurer. The insurance company will then determine what amount, they are obliged to pay. Any extra amount will be billed to you, which means you will have to pay out of pocket.
Why you may get separate bills from the ER
The emergency rooms that are attached to the hospital usually rely on the ER to treat ER patients. When you visit an ER, your insurance is going to be billed by the physician and facility. Besides that, each department that will treat you will bill you separately. Most departments are usually separate entities legally. It is only that they operate in the same building. Thus, they have to bill you separately.
However, if you visit a separate ER, it helps to eliminate the issues of multiple claims for the ER visit. Most of the emergency rooms that are standalone will bill your insurer for any services as part of your facility bill. The physician will still make a separate claim, which will lead to only two claims for the visit. By combining the billing, these standalone ERs help to speed up the processing of a claim.
How to deal with surprise bills
After you visit the ER for what seemed like a minor issue to you, you might receive a bill of thousands of dollars, which you are supposed to pay. However, you do not have to pay it and suffer in silence.
The first step you have to take is to check the bill. It is estimated that over 80 percent of all ER bills come with some errors. This can be worse if you visit an ER, which is usually very busy. The other step you can take is to make a complaint. In some cases, your insurer will determine that some of the services you received are not covered. However, if you make a complaint, a huge chunk of these complaints usually succeed.