I’m confused about some the different terms used for payment. How do insurance benefits work for an Emergency Room (ER) visit?
What is an E.O.B?
An explanation of benefits (EOB) statement usually arrives via mail from your insurance provider and is often confused as a medical bill. The EOB is not a bill. The EOB notifies the patient that a medical insurance claim has been processed and explains what PRELIMINARY portion was paid to the health care provider, and what portion of the payment, if any, is the patient’s responsibility.
I just received my EOB and the “out of pocket cost” is concerning me.
Please understand the EOB is a starting point and NOT a bill. There are usually subsequent adjustments on the account to allow for in network benefits.
Please wait for the Austin Emergency Center bill to understand any financial obligations. The bill will reflect any adjustments resulting from your insurance coverage.
I need an itemized bill; can AEC provide this?
We’re happy to help. For immediate service, please reach out directly to SJM Billing at 832-807-2956. Office hours are 7AM to 4PM, Monday through Friday.
I have questions about my bill. Who should I contact?
You’re not alone, medical bills are notoriously confusing and AEC has setup a process to help ensure you receive clear and quick answers to any questions you might have. If you need additional information about your bill:
My insurance company is claiming AEC is “out of network”. Can you help?
State and Federal law requires all patients to be reimbursed for emergency room visits by their insurance carrier, whether the emergency room is in-network or out of network. If your insurance company refuses payment for your emergency room visit, you can file a grievance with the Texas Department of Insurance.
To learn more about the Texas Department of Insurance, please visit http://www.tdi.state.tx.us.
Why haven’t I received a statement?
It usually takes 30-45 days for your insurance plan to process your claim. You will receive your EOB after processing and we will receive payment 2 weeks after that. If we are appealing a low consideration by your insurance for you, the process could take up to 60 days longer.
What does an “adjustment” mean?
An adjustment refers to the reduction made to your account to take into consideration the in-network allowable rate. We honor the insurance designated allowable rate.
What if I don’t have insurance?
At Austin Emergency Center, we put your medical needs first. If you do not have insurance, we’ll work with you on a cash fee schedule to help you cover your visit.