Billing & Insurance

Disclaimer to all patients:

The CMS (Center for Medicare and Medicaid Services) does not yet recognize Freestanding Emergency Centers which is why Prestige Emergency Room cannot currently accept the following medical insurances: Medicaid

 

Basic Steps in the Billing Process:

  1. Your visit will consist of (2) bills, which are sent to your insurance carrier. These bills cover the cost of the building, equipment, tests, clinicians, medication, supplies and the for the physician who treated you, a member of Prestige Emergency Consultants.
  2. The insurance company will process the claim and send you and EOB (Explanation of Benefits), this is not a bill. The EOB will show you a very large amount that will be negotiated down (please ignore the initial amount).
  3. Once the final bill is agreed upon by Prestige ER and the insurance carrier, the amount will be applied to your in-network ER benefits. For plans that have an in-network out of pocket maximum, the balance will not exceed that.
  4. Any remaining patient responsibility will be sent to you in the form of a bill from Prestige ER.

Note: Prestige Emergency Room does not balance bill under any circumstances. You will never pay more here than you would pay at a traditional hospital ER.

 

For billing questions or to set up a payment plan arrangement, please call 210-504-9122 (8 a.m-4 p.m).

Health Insurance Policy Misconceptions:

Misconception #1: "You shouldn't have gone to an out of network ER."

In fact, you should go to the nearest ER available at the time of your need. Under EMTALA, hospitals and FECs (Freestanding Emergency Centers) are required to provide stabilizing treatments for patients with emergency medical conditions. Under the Prudent Layperson Standard, you can receive care for any medical condition that has sudden onset symptoms and is becoming more severe (including sever pain) if you could reasonably expect the following to happen if you don't seek care:

  1. Placing the health of an individual or (for a pregnant woman, the health of the mother and unborn child) in serious jeopardy.
  2. Serious impairment to bodily functions.
  3. Serious dysfunction of any bodily organ or part.

Misconception #2: "We paid your ER claim at the correct rate because the ER is out of network and their charges are excessive."

Per Federal H.R.3590, your medical insurance must pay the greatest of the 3 rates below:

  1. The amount negotiated with in-network providers for the emergency service furnished.
  2. The amount for the emergency service calculated using usual, customary, and reasonable amount for the geographical area. (You can use fairhealthconsumer.com to determine this amount)
  3. The amount that would be paid under Medicare

Our charges are comparable to other emergency healthcare providers within this geographic area.

Misconception #3: "The ER facility used incorrect procedure and/or diagnosis codes."

We use the ACEP guidelines (American College of Emergency Physicians) for coding, which is the industry standard in coding for ER.

We appreciate you choosing Prestige ER for your emergency care. You pay for your medical insurance plan and its important that you are appropriately covered for your claims when you need it. We are here to help you get your claim processed correctly and protect you from financial burdens.