What you can expect
After your visit to the emergency room, multiple claims will be filed to your insurance carrier. CapRock Emergency will send one claim for the facility, the physicians, and if you receive any radiology services such as a CT, x-ray and/or ultrasound, a claim will be sent by Synergy Radiology for the interpretation.
Why am I receiving a bill when I already paid my co-pay?
At the time of service, your ER co-pay was collected. We then filed with your insurance for your ER benefits. The balance due represents your deductible, coinsurance, and other non-covered 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, the deductible starts over at the beginning of the calendar year and each family member must meet their own deductible.
What if my insurance says you are out-of-network?
Our facility is not a participating provider in any health benefit plan provider network, however, network status DOES NOT MATTER for emergency care (per Texas Insurance Code – Section 1301.155 – Emergency Care and SEC. 2719A [42 U.S.C. 300gg–19a]. PATIENT PROTECTIONS). Texas Insurance LAW guarantees that all fully-funded medical insurance plans must pay for ALL emergency medical claims at the in-network level regardless of network status. This means that your visit will be processed under your in-network benefits. If your insurance company does not process it correctly the first time, our billing company will work on your behalf to correct the insurance company’s error, and get your claim processed in-network under your emergency room benefits. Quite simply it is a violation of law for your insurance company to refuse to pay in-network for an emergency visit to a licensed ER such as CapRock ER. If you need assistance, please don’t hesitate to contact our billing company, they are here to help!
How you can help
Be familiar with your benefits. Take the time to review your insurance policy. Find out if you have deductibles, coinsurance or anything else that may be your responsibility. This knowledge will help you make educated decisions in seeking medical care.