Understanding Your Rights in an Emergency

In an emergency, every second matters. You certainly can’t afford to stop and read the fine print on your health insurance…and according to Texas Guidelines, you don’t have to waste a minute worrying. The law states that your insurance carrier must pay for your emergency care, whether the emergency room is “in-network” or “out-of-network.” In fact, according to these Texas Guidelines, all insurance carriers are required to pay in-network benefits for any member needing emergency medical treatment. You are empowered to choose the ER you want, no matter what your insurance company tells you.

How do you know if it’s really an emergency? Dr. Shannon Orsak, Co-Founder of St. Michael’s Emergency Rooms, says, “The state of Texas has adopted “the prudent layperson standard.” If you think that your symptoms or those of someone in your care are serious enough to go to an emergency room, the most convenient emergency room is the right choice. If you believe that waiting for hours to see a doctor in an emergency room could compromise their health or life, an emergency room (such as St. Michael’s) which offers a short wait time is the best choice.”

State law bans health insurance from requiring prior authorization for emergency services…because how could you know in advance that an emergency was about to happen? In addition, state law absolutely requires patients to be reimbursed for emergency room visits by their insurance carrier at the same rate, regardless of whether they are treated at “in-network” or “out-of-network” facilities. If your insurance company refuses payment for your emergency room visit, you can file a grievance with the Texas Department of Insurance. Patients have told us that St. Michael’s does an amazing job of going to bat with insurance companies to defend your rights.

Are you going to get better sitting around a waiting room? By law you’re entitled to concierge emergency room treatment at the same price you’d pay to sit around an impersonal ER for hours. Dr. Orsak says, “St. Michael’s Emergency Room is not an urgent care center…it’s a 10,000 square foot full-fledged, free-standing Emergency Room with physicians trained in emergency medicine, X-ray, Ultrasound and CT, an on-site diagnostic lab, nine exam rooms (including pediatric themed rooms and a Harley-Davidson room!), a treatment suite for observation, and a comfortable waiting room…with a limited wait time! St. Michael’s is one of the only fully-accredited ER facilities with JCAHO, ACR, and CLIA certifications. We are in-network with AETNA and also accept more than 200 insurance plans, including Cigna, Blue Cross, United, and Humana. We’re here to care for you from start to finish!”
Know your rights in an emergency….and make your next stop St. Michael’s!

At this time, Medicare, Medicaid, and Tricare do not participate with free-standing ER’s.

St. Michael’s Emergency Center
16062 SW Freeway (at Hwy 6)
Sugar Land, TX 77479

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