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Our Billing Process
At Excel ER Odessa, we strive to make the billing process as smooth and transparent as possible. We owe that to our valued patients. Though Excel ER is not a participating provider in any health benefit plan provider network, by state law all insurance carriers are required to process your ER visit at in-network benefits levels (see “Know Your Rights” below).
After you have been seen at our facility, our billing department will submit two claims to your insurance company. The first will be from the physician who cared for you and the second will be for the facility in which you were seen. The facility charge will include all lab tests, x-rays, CT scans, cultures, etc. that you may have received.
After we submit the claims to your insurance carrier, you will receive an explanation of benefits (EOB) from your insurance company. Keep in mind that this is not a bill. This EOB will explain the charges from our facility with regard to the emergency care you received. The EOB may itemize your copay, deductible and co-insurance, as well as your potential payment responsibility. Our billing department has received the same EOB and if it was not processed appropriately “in-network” they will begin an appeals process (see “Know Your Rights” below). Again, please keep in mind this is not a bill and your ER visit is required to be processed on an in-network basis.
After the final EOB has been processed, and if there is an outstanding balance due, you will be issued a single invoice transparently showing the separate charges including the facility and physician charge all summarized into a single amount due. If you have any questions about your invoice, please do not hesitate to call our billing department at the number listed. We frequently offer courtesy discounts or other payment options. Excel ER Odessa does not engage in the practice of balance billing. This means we do not bill above and beyond what your insurance company’s in-network allowable is for the service we provide. Our goal is to provide great care and fair billing so you are comfortable bringing your family member back in case emergency care is needed.
Emergency Room Billing and Insurance Coverage
Because CMS does not yet recognize Freestanding Emergency Departments, Elite Care 24 Hour Emergency Room cannot accept Medicare, Medicaid, or Tricare at this time. We are working with the Texas Association of Freestanding Emergency Centers (TAFEC) to change this status.
Know Your Rights
The 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” (i.e., use in-network deductibles, co-pays and co-insurance rates) for all emergency services. Also, because the Affordable Care Act (ACA) defines emergency care as an essential healthcare benefit, a person cannot be penalized for receiving emergency care at a Freestanding Emergency Center. Sometimes insurers attempt to avoid these ACA (or other) payment obligations and this can sometimes result in annoying billing issues for patients. If this happens to you, please contact us right away and we can help address the inaccurate billing by your insurance provider. Excel ER Odessa does not participate in Balance Billing. Please know that Excel ER Odessa will never bill you for anything above your “in-network” rate.
We are your advocates.
Care from Excel ER Odessa doesn’t end when patients leave our facility. Our Patient Advocate team is there for you to help navigate insurance, billing, reimbursement, and just to make sure you are doing well. We strive to create a seamless, stress-free process so you can have more time for your busy life and family.
Per Senate Bill 425, which took effect September 1, 2015, and House Bill 3276, which took effect September 1, 2017, the following notice must be posted:
- This is a freestanding emergency medical care facility.
- This facility charges rates comparable to a hospital emergency room and may charge a facility fee.
- This facility is not a participating provider in any health benefit plan provider.
- However, by state law, your health insurance company is required to process your emergency medical care at in-network benefit levels.
- The physician providing medical care at this facility may not be a participating provider in the patient’s health benefit plan provider network.
- The physician providing medical care at this facility may bill separately from the facility for the medical care provided to a patient (this is not the case at Excel ER Odessa).