Insurance and billing

Insurance Information

At Memorial Springs ER, we understand that navigating healthcare bills and dealing with insurance companies can often be overwhelming and confusing. We are committed to assisting you with the process and addressing any inquiries you might have, whether they pertain to insurance claims or questions regarding your billing statements. Feel free to reach out to us for guidance and clarity at any time.

What Should You Anticipate in Terms of Expenses?

Thanks to reduced operational costs, our emergency room fees are frequently lower than those of conventional hospital-based ERs. Despite this, we maintain equivalent capabilities, possess state-of-the-art equipment, and are staffed by skilled medical professionals, ensuring you receive the same high-quality care.

Accepted Insurance Plans

We welcome all major insurance plans, including

BlueCross BlueShield

United Healthcare
UMR
Aetna
Humana
Ambetter
Cigna
Kaiser
Community Health Choice
Anthem
Highmark
MultiPlan
and many others.

Give us a call at 346-899-6737 to find out if Memorial Springs ER is in the network of your insurance provider.

Alternative Payment Options

For individuals without insurance coverage or those opting not to utilize it, we provide a significant reduction in fees when payment is rendered in full during the service visit. We accept all major credit cards and can coordinate structured payment schedules or explore third-party financing alternatives for eligible patients.

Texas Senate Bill 425

Senate Bill 425, passed by the Texas Legislature during the 84th Regular Session, requires all FECs to post notice of the following:

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 or physician providing medical care at this facility may not be a participating provider in your Health Benefit Plan provider network
A physician providing medical care at this facility may bill separately from the facility for the medical care provided to you

Texas House Bill 3276

If we are not in-network with your particular health plan, Federal law requires insurance companies to process your ER visit at the in-network benefit level.

We are not recognized yet by Medicaid or Medicare. If you would like to assist us in being able to accept these insurance coverages, please contact your legistators.

Texas House Bill 2041

House Bill 2041, passed by the Texas Legislature during the 86th Regular Session, requires all FECs to post notice of the following:

This is a Freestanding Emergency Medical Care Facility
This facility is an out-of-network provider for all health benefit plans.
This facility charges rates comparable to a hospital Emergency Room and may charge a facility fee.
The facility or physician providing medical care at this facility may be an out of network provider for the patient health benefit plan provider network.
A physician providing medical care at this facility may bill separately from the facility for the medical care provided to the patient.
In addition, as required by the Texas House Bill 2041, our facility has provided a complete list of charges for all services and items provided by our facility. You can view the fee schedule here.
Questions concerns regarding this matter may be directed to the administration of this facility at 346-899-6737

Este centro es un centro de atención médica de emergencia independiente. Este centro es un proveedor fuera de la red para todos los planes de beneficios de salud. Esta instalación cobra tarifas comparables a una sala de emergencias de hospital y puede cobrar una tarifa de centro por tratamiento médico; Un centro o un médico que proporciona atención médica en el centro puede ser un proveedor fuera de la red de proveedores del plan de beneficios de salud del paciente; El médico que proporciona atención médica en el centro puede facturar por separado del centro por la atención médica proporcionada a un paciente; Esta instalación es un proveedor fuera de la red para algunos planes de beneficios de salud.

Senate Bill 2038

Freestanding ERs are required to publicly share testing charges or vaccinations for an infectious disease when a state of disaster has been declared.

FFCRA & CARES ACT PROVIDER COMPLIANCE INFORMATION

Pursuant to section 6001 of the Families First Coronavirus Response Act (the “FFCRA”) as amended by Sections 3201 and 3202 of the Coronavirus Aid, Relief, and Economic Security Act (the “CARES Act”) specifically as the foregoing relate to the provision and reimbursement of orders for and or administration of SARS-CoV-2 or COVID-19 (collectively, “COVID-19) in vitro diagnostic tests (including serological tests used to detect COVID-19 antibodies) as well as the provision and reimbursement of items and services furnished to individuals during visits that result in an order for, or administration of a COVID-19 in vitro diagnostic test(s) and or the provision and reimbursement of services related to the evaluation of such individuals by the attending healthcare provider for purposes of determining the need for the product or service in question, the following are the lists by provider of CPT codes (refer to fee schedule for associated cash prices) required by section 3202 (b) of the CARES Act related to the foregoing COVID-19 in vitro diagnostic testing services as well as said related items and services:

SARS-COV-2 COVID-19 ANTIBODY
SARSCOV2 COVID19 PCR

Your Rights and Protections Against Surprise Medical Bills

When you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing.

What is “balance billing” (sometimes called “surprise billing”)?

When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, such as a copayment, coinsurance, and/or a deductible. You may have other costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network. “Out-of-network” describes providers and facilities that haven’t signed a contract with your health plan. Out-of-network providers may be permitted to bill you for the difference between what your plan agreed to pay, and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your annual out-of-pocket limit. “Surprise billing” is an unexpected balance bill. This can happen when you cannot control who is involved in your care—like when you have an emergency or when you schedule a visit at an in- network facility but are unexpectedly treated by an out-of-network provider.

You are protected from balance billing for:

Emergency Services

If you have an emergency medical condition and get emergency services from an out-of- network provider or facility, the most the provider or facility may bill you is your plan’s in- network cost-sharing amount (such as copayments and coinsurance). You can’t be balance billed for these emergency services. This includes services you may get after you’re in stable condition unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services.

In accordance with the No Surprise Act requirement the beneficiary or guarantor receiving services at Quality Care ER will not be balanced billed for any amounts which are considered not allowable by your insurance company. The guarantor or beneficiary will only be billed for co-pays, deductibles and co-insurance amounts in accordance with the insurance plan.

Certain services at an in-network hospital or ambulatory surgical center

When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers may bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers can’t balance you and may not ask you to give up your protections not to be balance billed. If you get other services at these in-network facilities, out-of-network providers cannot balance bill you, unless you give written consent and give up your protections.

You’re never required to give up your protections from balance billing. You also aren’t required to get care out-of-network. You can choose a provider or facility in your plan’s network.

This facility is in compliance with HB2041. This information is provided to you in a separate disclosure. This facility does not balance bill for any out-of-network services.

When balance billing isn’t allowed, you also have the following protections:

You are only responsible for paying your share of the cost (like the copayments, coinsurance, and deductibles that you would pay if the provider or facility was in-network). Your health plan will pay out-of-network providers and facilities directly. Your health plan generally must:

Cover emergency services without requiring you to get approval for services in advance (prior authorization).
Cover emergency services by out-of-network providers.
Base what you owe the provider or facility (cost-sharing) on what it would pay an in-network provider or facility and show that amount in your explanation of benefits.
Count any amount you pay for emergency services or out-of-network services toward your deductible and out-of-pocket limit.

If you believe you’ve been wrongly billed, you may contact Texas Health and Human Services at (800) 458-9848 or email hfc.complaints@hhs.texas.gov

Visit cms.gov/nosurprises for more information about your rights under federal law.

For more information about your rights under Texas state laws visit:

Texas protects consumers from surprise

Usted Derechos y Protecciones Contra Sorpresa Médico Cuentas

Cuando recibe atención de emergencia o recibe tratamiento de un proveedor fuera de la red en un hospital o centro quirúrgico ambulatorio dentro de la red, está protegido dela facturación sorpresa o la facturación del saldo.

¿Qué es la "facturación de saldo" (a veces llamada "facturación sorpresa")?

Cuando vea a un médico u otro proveedor de atención médica, es posible que deba ciertos costos de su bolsillo, como un copago, un coseguro y / o un deducible. Es posible que tenga otros costos o tenga que pagar la factura completa si ve a un proveedor o visita un centro de atención médica que no está en la red de su plan de salud. "Fuera de la red" describe a los proveedores e instalaciones que no han firmado un contrato con su plan de salud. Es posible que a los proveedores fuera de la red se les permita facturarle la diferencia entre lo que su plan acordó pagar y el monto total cobrado por un servicio. Esto se llama "facturación desaldo". Es probable que esta cantidad sea mayor que los costos dentro de la red para el mismo servicio y es posible que no cuente para su límite anual de desembolso. La "facturación sorpresa" es una facturade saldo inesperada. Esto puede suceder cuando no puede controlar quién está involucrado en su atención, como cuando tiene una emergencia o cuando programa una visita en un centro dentro de la red, pero es tratado inesperadamente por un proveedor fuera de la red.

Usted está protegido de la facturación del saldo por:

Servicios de emergencia

Si tiene una afección médica de emergencia y recibe servicios de emergencia de un proveedor o centro fuera de la red, lo máximo que el proveedor o centro puede facturarle es el monto de costos compartidos dentro de la red de su plan (como copagos y coseguros). No se le puede facturar el saldo de estos servicios de emergencia. Esto incluye los servicios que puede obtener después de estar en condición estable a menos que dé su consentimiento por escrito y renuncie a sus protecciones para que no se le facturen de manera equilibrada por estos servicios posteriores a la estabilización.

De acuerdo con el requisito de la Ley De No Sorpresa, el beneficiario o garante que reciba servicios en Excel ER nose le facturará de manera equilibrada por ningún monto que su compañía de seguros considere no permitido. Al garante o beneficiario solo se le facturarán los copagos, deducibles y montos de coseguro de acuerdo con el plan de seguro.

Ciertos servicios en un hospital o centro quirúrgico ambulatorio dentro de la red

Cuando recibe servicios de un hospital o centro quirúrgico ambulatorio dentro de la red, ciertos proveedores pueden estar fuera de la red. En estos casos, lo máximo que esos proveedores pueden facturarle es el monto de costos compartidos dentro de la red de su plan. Esto se aplica a la medicina de emergencia, anestesia, patología, radiología, laboratorio, neonatología, cirujano asistente, hospitalista o servicios intensivistas. Estos proveedores no pueden equilibrarlo y es posible que no le pidan que renuncie a sus protecciones para que no se les facture el saldo. Si obtiene otros servicios en estas instalaciones dentro de la red, los proveedores fuera de la red no pueden equilibrar la factura, a menos que usted dé su consentimiento por escrito y renuncie a sus protecciones.

Nunca se le pedirá que renuncie a sus protecciones de la facturación del saldo. Tampoco está obligado a recibir atención fuera de la red. Puede elegir un proveedor o instalación en la red de suplan.

Esta instalación cumple con HB2041. Esta información se le proporciona en una divulgación separada. Esta instalación no equilibra la factura de ningún servicio fuera de la red.

Cuando no se permite la facturación de saldo, también tienes las siguientes protecciones:

Usted solo es responsable de pagar su parte del costo (como los copagos, el coseguro y los deducibles que pagaría si el proveedor o la instalación estuviera dentro de la red). Su plan de salud pagará directamente a los proveedores e instalaciones fuera de la red. Su plan de salud generalmente debe:

Cubra los servicios de emergencia sin necesidad de obtener la aprobación de los servicios por adelantado (autorización previa).
Cubrir los servicios de emergencia de proveedores fuera de la red.
Base lo que le debe al proveedor o instalación (costo compartido) en lo que pagaría a un proveedor o instalación dentro de la red y muestre esa cantidad en su explicación de beneficios.
Cuente cualquier cantidad que pague por servicios de emergencia o servicios fuera de la red para su deducible y límite de desembolso.

Si cree que se le ha facturado incorrectamente, puede comunicarse con Texas Health and Human Services al (800) 458-9848 o enviar un correo electrónico ahfc.complaints@hhs.texas.gov

Visite cms.gov/nosurprises para obtener más información sobre sus derechos bajo la ley federal.

Fo más información sobre sus derechos bajo las leyes estatales de Texas visite:

How consumers are protected from surprise medical bills