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. You can find our required legal posting here.

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 a freestanding emergency medical care facility;
  • Surepoint Emergency Center charges rates comparable to a hospital emergency room and may charge a facility fee;
  • Surepoint Emergency Center or a physician providing medical care in this facility may be an out-of-network provider for the patient’s health benefit plan provider network;
  • A physician providing medical care at the facility may bill separately from the facility for the medical care provided to a patient;
  • Surepoint Emergency Center is an out-of-network provider for all health benefit plans.

For more information about House Bill 2041, click here.

Required Disclosures:

House Bill 2041 Patient Notice – English

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

 

 

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 or testing of asymptomatic patients. 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. The final price may include the additional cost of an emergency room physician’s physical assessment. Patient responsibility will be discussed prior to any treatment.

Pursuant to section 6001 of the Families First Coronavirus Response Act (the “FFCRA”) as amended by Sections 3201 and 3202 of the Coronavirus Aid, Relief, and Economic Security Act (the “CARES Act”) specifically as the foregoing relate to the provision and reimbursement of orders for and or administration of SARS-CoV-2 or COVID-19 (collectively, “COVID-19) in vitro diagnostic tests (including serological tests used to detect COVID-19 antibodies) as well as the provision and reimbursement of items and services furnished to individuals during visits that result in an order for, or administration of a COVID-19 in vitro diagnostic test(s) and or the provision and reimbursement of services related to the evaluation of such individuals by the attending healthcare provider for purposes of determining the need for the product or service in question, the following are the lists by provider of CPT codes and associated cash prices required by section 3202 (b) of the CARES Act related to the foregoing COVID-19 in vitro diagnostic testing services as well as said related items and services

 

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