Billing and Insurance

At Golden Triangle Emergency Centers, we participate with private insurance plans, including Aetna, United Health, Humana, BlueCross/BlueShield, Cigna, Tricare, and USFHP. Both locations can honor your in-network benefits, even if GTEC is not a part of your provider’s network.
We also accept out-of-pocket payment in the form of cash, checks or credit cards. Our rates for self-pay are very reasonable. To get a quote for care, come in today for a complimentary basic medical screening.

Senate Bill 425

Golden Triangle Emergency Center is an emergency room.
Golden Triangle Emergency Center charges rates comparable to a hospital emergency department, including a possible facility fee.
• The physician may bill separately from the facility.
Golden Triangle Emergency Center 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 Network Coverage

The state of Texas empowers patients to use what is called the prudent layperson standard when considering if what they are experiencing constitutes an emergency. Furthermore, according to Texas guidelines insurance carriers are required to pay in-network benefits for members seeking emergency treatment. Thus, Texas law requires all insurance carriers to pay for emergency care, even if the facility is out of network.

State law further mandates that patients be reimbursed for their emergency room visits by their insurance carriers. If your insurance company won’t reimburse you for your emergency room visit, you can file a complaint with the Texas Department of Insurance. To do so and for additional information please visit http://www.tdi.state.tx.us.

Understanding your Bill

GTEC understands that you may find medical billing to be a complicated process. At Golden Triangle Emergency Centers, we strive to be completely fair and transparent in our billing polices. We want to help patients understand the bills they receive from us, which may be different from medical bills received from other hospitals or physicians.
Golden Triangle Emergency Centers are licensed freestanding emergency centera. We function just like a hospital-based emergency room. Thus, according to Texas law, all insurance carriers have a requirement to pay in-network benefits for emergency medical treatment and to reimburse members accordingly.

Insurance Benefits

After your visit to one of our Golden Triangle Emergency Center locations you will receive something known as an Explanation of Benefits (EOB) from your insurance company via mail that will explain our charges. Please note the EOB is not a bill, but depending on your insurance plan there may be additional charges due, for which you will receive a bill.

GTEC is out of network with most insurance companies, but honors all in-network deductibles and benefits. We’ll also contact your insurance company to inform them that we are honoring in-network benefit.

Make sure to carefully review your EOB in order to familiarize yourself with your policy including benefits, deductibles, co-insurance, and any charges they may be your responsibility.

Our Billing Policy

We’ll collect your emergency room co-pay at the time of your visit and will then bill your insurance company for your policy’s ER benefits.

Two claims will be filed with the insurance company: one for the facility, the other for the physician. Your insurance company isn’t charged separately for things like radiology, pathology, or cardiology over-reads, which are instead included in the facility bill, as is typically the case with hospital-based ER bills.

Emergency rooms maintain a very high level of preparedness to effectively treat emergency medical conditions. This high level of preparedness must be maintained in order to ensure that all patients have access to the best emergency medical care possible; however, the high level of preparedness is also much more costly than it is for non-emergency medical facilities like doctors’ offices. Thus, to offset these costs each patient is charged a facility fee.

Facility fees are calculated on a point system, which is based on various factors including the procedures performed, the complexity of the physician/patient interaction, patient acuity, and the potential liability.

If you have questions about your GTEC bill or our billing and insurance policies in general please contact Tyvan Billing at 713.357.2535.

Leave a Reply

Your email address will not be published. Required fields are marked *

*
*