Insurance & Covid-19 Information

Guidelines for Texas Emergency Rooms

According to the state of Texas mandate, insurance carriers are required to pay in-network benefits to members receiving emergency medical treatment. It is Texas law that your insurance provider pay for your emergency room treatment, even if the provider typically classifies the facility as “out-of-network.” You are empowered by Texas state law to use the prudent layperson standard when deciding if you have a medical emergency.

Emergency care is defined as health care services provided in a freestanding emergency medical care facility to evaluate and stabilize a medical condition of recent onset and severity, including severe pain, that would lead a prudent layperson possessing an average knowledge of medicine and health to believe that the person’s condition, sickness, or injury is of such a nature that failure to get immediate medical care could result in placing the person’s health in serious jeopardy

Your insurance provider is required to reimburse you for emergency treatment. If your insurance company refuses to reimburse you for your emergency room visit, you may file an official complaint with the Texas Department of Insurance. For additional info about the Texas Department of Insurance, go to http://www.tdi.state.tx.us.

All freestanding emergency centers shall provide, without regard to the individual’s ability to pay, an appropriate medical screening, examination, and stabilization within the facility’s capability to determine whether an emergency medical condition exists and any necessary stabilizing treatment.

Texas House Bill 2041

• Surepoint Emergency Center is an emergency room.
Surepoint Emergency Center charges rates comparable to a hospital emergency department, including a facility fee.
• The physician may bill separately from the facility.
Surepoint Emergency Center and facility-based physicians may not be a participating provider in an individual’s health plan network.

For more information about House Bill 2041, click here.

 

Requirements Imposed by Families First Coronavirus Relief Act

Insured Patients

A group health plan and a health insurance issuer offering group or individual health insurance coverage (including a grandfathered health plan (as defined in section 1251(e) of the Patient Protection and Affordable Care Act) shall provide coverage, and shall not impose any cost-sharing (including deductibles, copayments, and coinsurance)

Uninsured Patients

Public health and Social Services Emergency Fund reimbursement for testing of uninsured individuals.

 

Cares Act and Covid-19 Testing

Providers must clearly publicize the cash price of the COVID-19 test on the website (or be subject to civil monetary penalties up to $300 per day while the violation is ongoing. Surepoint Emergency Center Covid-19

We are an emergency room facility and per our mission, we are a comprehensive emergency medical facility. Because of the type of facility and services that we offer we do not offer standalone testing for COVID-19. Our pricing of a comprehensive treatment plan may include Covid-19 testing of which the cost for the test, not including any and all other necessary testing and/or services is charged at $150 for a Covid-19 Rapid, point-of-care diagnostic test and $450 for a Covid-19 PCR swab test.

 

Further Information & Resources

House Bill 2041 Patient Notice – English

Aviso para el paciente sobre el proyecto de ley de la Cámara 2041 – Español

Texas Department of Insurance