Frequently Asked Questions

We file and process health insurance claims with all major private insurance plans. 

Many insured patients inquire about an emergency room’s network status because they are worried about their potential total out-of-pocket cost. For insured patients, the answer is simple – no matter what emergency room you seek care in, both state and federal law prevents insurance companies from making you pay more in one emergency room vs. another for copays, deductibles and coinsurance. That means that under your plan, all emergency rooms are financially identical – “in-network” or “out-of-network”, because your financial contribution requirement (your total out-of-pocket costs) will be the exact same in both.

So, from the standpoint of your total out-of-pocket cost for an emergency room visit, there is no difference between an “in-network” and “out-of-network” emergency room – financially they are all the same (every single one of them in the country). That means you and any other insured patient, can go to any emergency room you wish (the one you like, and that you feel is best for you and your family) without the fear of having to pay more for copays and deductibles in one versus another – your in-network benefits are always applied – there will be no difference in cost to you.

Why is this the case? The laws that require health insurance companies to apply your in-network benefits are specifically designed to protect the patient seeking care in an emergency by ensuring they remain focused on finding the care they require as quickly as possible as opposed to needlessly worrying about the network status of one emergency room vs. another.

Since it opened its doors in 2014, America’s ER Medical Centers has always sought to minimize its patients’ out of pocket expenses. As a result, in all that time, and having seen tens of thousands of patients, America’s ER Medical Centers has never balanced billed a single patient – not one. Instead, we have worked day in and day out since opening, challenging insurance companies any time they’ve tried to shift their legally dictated financial responsibility to our patients, and we will continue to do so in order to keep the direct cost to our patients as small as possible.

So, don’t let insurance companies fool you into limiting your healthcare choices – especially when seeking care in an emergency room.  Just remember….

• No matter what emergency room you chose, you’re always entitled to your plan’s “in-network” benefits; 
• An explanation of benefits from your insurance company (an “EOB”) is not a bill from America’s ER Medical Centers, and likely does not accurately reflect what you may owe;
• America’s ER Medical Centers has never balanced billed a single patient – not one.

Additionally, we now offer AblePay which can lower your payment by up to 13% for free.

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America’s ER Medical Centers (“AER”) publishes its service fees to help our patients understand both their healthcare costs as well as what their health insurance companies are required to cover. While AER is solely responsible for the fees appearing on its charge master, AER derives those fees from the licensed Emergency and Urgent Care charge data it receives from Fair Health, Inc. (“Fair Health”).

Fair Health is an independent and neutral, national nonprofit organization. It is neither affiliated with nor controlled by healthcare insurance companies or healthcare providers. In fact, Fair Health was specifically created to increase transparency to consumers like you by providing non-biased and accurate information regarding the cost of healthcare services you’d expect to find in your community. In fact, the Texas Department of Insurance recently selected FAIR Health to provide healthcare cost benchmarks data to support the state’s price transparency initiative. Fair Health can offer consumers this reliable information because each year, health insurers around the country send it over a billion healthcare bills which are added to its ever-growing database of more than 25 billion healthcare claims. Fair Health maintains the accuracy of healthcare information by making its data specific to the geographical area where healthcare services are provided and by updating that geographically specific healthcare data twice a year.

While Fair Health retains all rights in and to the information in its healthcare database, AER utilizes that accurate and non-biased data to establish and regularly update its usual and customary charges so those charges always approximate the costs listed in the 80th percentile of Fair Health’s charge data. Fair Health’s healthcare information, including the data used by AER to develop its service fees, is publicly available to everyone at Fairhealthconsumer.org.

While Fair Health does not publish charge data for professional services rendered in an emergency room, AER utilizes the facility charge data that is published by Fair Health to establish its usual and customary professional service charges. This charge approximation is accomplished by attempting to employ the same methodology used by the Centers for Medicare and Medicaid Services (“CMS”) to determine reimbursement for professional services rendered to CMS patients.

The most you’ll ever have to pay at the time of service: As with all Emergency Rooms, Urgent Care clinics and Doctors’ offices, we collect a copayment (copay) at the time of service. Copays vary in amount and are determined by your specific policy and whether you received treatment in the Medical Center’s Emergency Room or Urgent Care Center.

The most you’ll ever have to pay in the emergency room: Because both state and federal law requires health insurance companies to utilize your in-network benefits for services you receive in an emergency room, the most you will ever have to pay (your total out-of-pocket expense) will never exceed your in-network copay, deductible and/or co-insurance.

On your behalf, our billing specialists will submit your claim to your insurance company. Several weeks after your visit, your insurance company will send you an “Explanation of Benefits (EOB)” detailing how it intends to process your claim including what it feels you owe out-of-pocket for deductibles and/or co-insurance. You may even receive more than one EOB, such as one for the facility and one for the physician. It is important to remember, EOBs from your insurance company are NOT bills from an America’s ER Medical Center and may not reflect what you owe – if you owe anything at all.

Most importantly, please call us as soon as you receive your EOB so we can check the status of your claim and to ensure your insurance company has processed your claim correctly. While the initial claim and subsequent appeal process generally takes some time, it’s important to remember that you will never owe more than your in-network benefits.

Our friendly staff will gladly answer any questions you may have regarding the status of your claim, clarify what you actually owe – if anything, and will work with you each step of the way to make the experience as easy and convenient as possible.

If you feel you are experiencing an emergency and seek treatment at any emergency department, including the ER in our Medical Center, your health insurance company is required by state and federal law to apply your in-network cost sharing benefits (copay, deductibles, and/or co-insurance) — even if the emergency room you visit is not listed as in-network. If your insurance company refuses payment for your visit, you can file a grievance with the Texas Department of Insurance. Please visit https://www.tdi.texas.gov/hprovider/providercompl.html to learn more. In addition, our billing specialists will file an appeal with your insurance company on your behalf and will handle the entire appeals process for you.

After your visit, your insurance company will mail you an “Explanation of Benefits (EOB)” detailing the benefits paid out based on your specific plan and what they claim you owe—including amounts applied to your remaining deductible or any co-insurance. You may even receive more than one EOB, such as one for the facility and one for the physician.

It is important to remember, EOBs from your insurance company are NOT bills from an America’s ER Medical Center and may not reflect what you owe – if you owe anything at all.

Most importantly, please call us as soon as you receive your EOB so we can check the status of your claim and to ensure your insurance company has processed your claim correctly. While the initial claim and subsequent appeal process generally takes some time, it’s important to remember that you will never owe more than your in-network benefits.

For patients who do not have insurance or do not want to use it, we offer a substantial discount when payment is made in full at the time of service. All major credit cards, such as MasterCard, Visa, American Express and Discover are accepted.

Additionally, we encourage you to sign up for AblePay for free. AblePay can save you up to 13% on your out-of-pocket expenses.

Sign up for free today!

No! Because we have both an Emergency Room and 24/7 Urgent Care Center, we are able to bill patients based on the severity of their condition and which department they receive medical treatment. Urgent Care is billed at urgent care rates, and Emergency Care is billed at ER rates.

Our Medical Centers base their fees on the usual and customary charges for like kind services in the geographical area where they are located. Those usual and customary fees are based upon publicly available data collected by Fair Health, a neutral third party with an openly available online national database comprised of treatment and procedure charges which is also used by the Texas Department of State Health Services as their official benchmark healthcare charge database. In order to facilitate healthcare pricing transparency, all of our Fair Health derived charges are regularly updated and published on this website.

Because the Medical Centers’ Emergency Rooms base their fees on the usual and customary rate, their charges are likely comparable to hospital emergency rooms that provide the same services, and which are also located in the same geographical area. Like those hospital emergency rooms, our Emergency Rooms do charge a facility fee which is separate from the fee which may be charged by the attending emergency room physician. While the Medical Center’s Emergency Rooms may not be in-network with your health insurance company, both state and federal law requires health insurance companies to utilize your in-network benefits for services you receive in all ERs, so the most you will ever have to pay (your total out-of-pocket expense) will never exceed your in-network copay, deductible and/or co-insurance.

A Facility Fee is a service fee charged by a healthcare facility to cover the cost of operating and staffing the emergency room and hospital 24/7/365. These overhead costs allow to provide our services to include but are not limited to utilities, supplies, providing and maintaining advanced diagnostic equipment, employing qualified nursing personnel and support medical and administrative staff, as well as the facility itself.

A Professional Fee is the cost for services provided by the physician.

Unlike Emergency Rooms, Urgent Care clinics are unlicensed and unregulated healthcare facilities in most states. Because they are not required to have on-site physicians providing direct patient care, many urgent care clinics are staffed with nurse practitioners or physician assistants. In contrast, Emergency Rooms are required by law to be staffed with on-site physicians who have extensive experience in pediatric and adult emergency medicine and are current on all certifications.

Also, due to the lack of stringent regulations, the clinical capabilities of urgent care centers vary among facilities and can be quite limited in nature. Because they are unlicensed, some are not equipped with diagnostic imaging or a CLIA-certified laboratory to help ensure proper diagnoses.

And lastly, urgent care clinics typically have limited hours of operation, and they treat conditions that are less severe than those requiring treatment in the emergency room. Therefore, the fees associated with urgent care services are less expensive than emergency rooms.

The Urgent Care Center at America’s ER Medical Centers is vastly different from others. We are open 24/7 for your ultimate convenience. And because of the strict state regulations followed by our Emergency Room, which is located under the same roof, we provide access to state-of-the-art equipment and high quality medical care by on-site experienced ER board-certified physicians. Wondering about cost? Treatment in our Urgent Care Center is billed at urgent care rates—not ER rates.

No. Because we have both an ER and 24/7 Urgent Care Center, we are able to bill patients based on the severity of their condition and which department they receive medical treatment. Urgent Care is billed at urgent care rates, and Emergency Care is billed at ER rates.

When our patients need follow-up care with either a primary care physician or specialist, we are happy to arrange a timely appointment with a physician in our growing referral network. In most cases, you will be able to see that doctor within a few days of leaving our facility, as opposed to waiting weeks for an appointment. We also have relationships with area hospitals and pharmacies to help you address all of your healthcare needs.

Our Urgent Care Center is open 24/7 and you never need an appointment for any of our services. Stop by when it’s convenient for you, and we’ll take care of you with little to no wait.

We are currently in network with BCBS and Medicare. We are constantly working to become in network with other healthcare insurance companies. 

If you would like us to discuss your visit with your doctor or child’s pediatrician, we are happy to do so. Seamlessly managing your care with your other healthcare providers is part of the service we offer our patients. Just provide us with your doctor’s contact information at the time of your visit, and we will forward your physician the requested medical information.

Nearly all lab tests require a physician’s order or prescription to be performed. We do provide patients the option to be evaluated in the Urgent Care Center by our attending physician, who can order any needed tests.