Montrose Emergency Room is a freestanding emergency room licensed by the State of Texas.
We are NOT an urgent care clinic. We are a full service free standing Emergency Room. Because of this, we must bill your insurance emergency room benefits.
Montrose Emergency Room is happy to bill your insurance company and works with all major private insurance plans. We are unable to accept government-sponsored insurance at this time, such as Medicare, Medicaid, CHIP or Tri-Care.
What happens at the time of my visit?
Montrose Emergency Room will collect the emergency room co-pay, and your insurance will be billed as per your emergency room benefits. Patients may also elect to be seen as self-pay patients.
What happens after my visit?
Your insurance company will receive two separate claims; one claim for the facility (Montrose Emergency Room) and one claim for the physician (Lough PLLC). Your insurance company will not be charged separately for radiology, pathology or cardiology over heads as with hospital based ERs. These charges are included in your facility bill.
Should you have any financial responsibility after your insurance company processes the claim, you will be responsible for those charges. If you disagree with the final outcome of the claim processing, please call our billing company for assistance.
Please be advised that Montrose Emergency Room is not contracted with any specific commercial insurance providers and is considered an out of network provider.
However, if you are judged to have a medical emergency, Texas insurance laws require commercial insurance companies to pay for all necessary emergency medical services, including those furnished by out of network providers, at in-network rates.
The determination of what constitutes an emergency medical condition is based on a prudent layperson definition, not the arbitrary definition of the insurance companies.
We cannot anticipate accurately what specific rates your carrier will apply for individual services rendered.
We encourage you to contact our billing company if you have any concerns, questions, or have difficulty paying your bill. You can contact the billing company, Win & Associates, at 713-554-6300.
Your Rights and Protections Against Surprise Medical Bills
When you get emergency care or are treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from balance billing. In these cases, you shouldn’t be charged more than your plan’s copayments, coinsurance and/or deductible.
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, like a copayment, coinsurance, or deductible. You may have additional 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” means providers and facilities that haven’t signed a contract with your health plan to provide services. Out-of-network providers may be allowed to bill you for the difference between what your plan pays 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 plan’s deductible or annual out-of-pocket limit.
“Surprise billing” is an unexpected balance bill. This can happen when you can’t 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. Surprise medical bills could cost thousands of dollars depending on the procedure or service.
You’re protected from balance billing for:
If you have an emergency medical condition and get emergency services from an out-of-network provider or facility, the most they can bill you is your plan’s in-network cost-sharing amount (such as copayments, coinsurance, and deductibles). 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.
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 can 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 bill you and may not ask you to give up your protections not to be balance billed.
If you get other types of services at these in-network facilities, out-of-network providers can’t 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 out-of-network care. You can choose a provider or facility in your plan’s network.
When balance billing isn’t allowed, you also have these protections:
• You’re only responsible for paying your share of the cost (like the copayments, coinsurance, and deductible that you would pay if the provider or facility was in-network). Your health plan will pay any additional costs to out-of-network providers and facilities directly.
• Generally, your health plan must:
-Cover emergency services without requiring you to get approval for services in advance (also known as “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. o Count any amount you pay for emergency services or out-of-network services toward your in-network deductible and out-of-pocket limit.
If you think you’ve been wrongly billed, contact the federal No Surprises Help Desk at (800)985-3059 or the Texas Department of Insurance at (800) 252-3439,
Visit http://www.cms.gov/nosuprises/consumers for more information about your rights under federal law. Visit https://www.tdi.texas.gov/medical-billing/surprises-balance-billing.html for more information about your rights under Texas Law.