Senate Bill 425• Lufkin ER is an emergency room.
• Lufkin ER charges rates comparable to a hospital emergency department, including a facility fee.
• The physician may bill separately from the facility.
• Lufkin ER and facility-based physicians may not be a participating provider in an individual’s health plan network.
For more information about Senate Bill 425, click here.
In-Network vs. Out of NetworkAccording to Texas guidelines, all insurance carriers are required to pay in-network benefits for any member seeking emergency medical treatment. Texas law requires that your insurance carrier pay for your emergency care, whether the emergency room is in-network or out of network. The state of Texas empowers you to use a prudent layperson standard when considering what constitutes an emergency.
State law requires patients to be reimbursed for emergency room visits by their insurance carrier. If your insurance company refuses payment for your emergency room visit, you can file a grievance with the Texas Department of Insurance. To learn more about the Texas Department of Insurance, please visit http://www.tdi.state.tx.us.
Understanding your BillWe understand that you may find medical billing to be a complicated process. At Lufkin Emergency Center, we strive to be fair and transparent with our billing. We want to help you understand the bills you receive from us, which may be different from medical bills you’ve received from hospitals or physicians.
Lufkin Emergency Center is a licensed freestanding emergency center. We function just like a hospital-based emergency room. According to Texas Guidelines, all insurance carriers are required to pay in-network benefits for any member needing emergency medical treatment. In fact, the law states that you must be reimbursed by your insurance carrier for your emergency room visit. Texas law requires that your insurance carrier pay for your emergency care, whether the emergency room is in-network or out of network. The state of Texas empowers you to use a prudent layperson standard when considering what constitutes an emergency.
Insurance BenefitsIf you have insurance, you will receive an explanation of benefits (EOB) from the insurance company in the mail, explaining our charges. Please note this is not a bill. Depending on your insurance plans, there may be additional charges associated with this visit.
We are out of network with most insurance companies; however, we will honor all in-network deductibles and benefits. In addition, we will contact your insurance company and let them know we are honoring your in-network benefit.
You can make the process easier by reviewing the EOB from your insurance company to become familiar with your benefits. By taking the time to review your insurance policy, you will find out if you have deductibles, co-insurance, or anything else that might fall under your responsibility. This will help you make educated decisions when seeking medical care.
Our Billing PolicyAt the time of your visit, your emergency room co-pay will be collected, and we will bill your insurance carrier for your policy’s emergency room benefits.
Two separate claims will be mailed to your insurance company: one for the facility and one for the physician. Your insurance company will not be charged separately for radiology, pathology, or cardiology over-reads, as is the case with hospital-based ERs. Instead, these charges are included in your facility bill.
Emergency rooms must maintain an extremely high level of preparedness in order to effectively treat emergency medical conditions. This level of preparedness is considerably higher than at other, more traditional medical facilities. Emergency rooms charge a facility fee for each patient visit to help offset the recurring costs associated with maintaining this high level of preparedness. This is done to ensure you have access to an environment that provides the best in emergency care. The facility fee is a charge that is calculated on a point system, which is based on procedures performed, patient acuity, potential liability, and the complexity of the physician/patient interaction.
For more information or with questions concerning your bill please call Tyvan Billing at 713-357-2535.