Freestanding emergency room price transparency

Local News

SAN ANGELO, Texas – With over 200 freestanding emergency rooms in Texas, a bill has passed the Texas House that would demand price transparency, since these facilities have acquired a bad reputation with patients claiming they’ve received skyrocketing surprise bills.  

A freestanding ER is a fully functioning emergency room that is not attached to a hospital.

“These many people are going to the emergency rooms and their claims are being denied,” mentioned Dr. John Speck who is a doctor and co-owner of Concho Valley ER.

Lindsey Harmon, who is the Director of Marketing at Concho Valley ER also gave an insight on community members reactions to receiving paperwork with high numbers, saying, “people get the explanation of benefits, and they’re like… What?”

House Bill 2041 would require freestanding ERs to give patients a printed-out disclosure of accepted health plans and any possible additional charges, in English and in Spanish.  

However, locally owned Concho Valley ER claims that the problem that people are facing is not price transparency from freestanding ERs but that some insurances are not abiding by the “Prudent Layperson” standard.

“The Prudent Layperson law is to protect patients, so that if they feel they are having an emergency, they have the right to go to the emergency room to get the treatment that they deserve. Now, sometimes we are finding that the insurance companies are not honoring the spirit of this law and it seems like its people having a surprise coverage problem than a surprise billing problem,” explained Dr. Speck.

In other words, some patients are not covered for the cost of the pricey medical examination that is done to rule whether their condition is truly an emergency or not.

Since Concho Valley ER is not affiliated with a hospital, they do not participate in governmental programs such as Medicaid or Medicare, and they have put up signs in their lobby making that clear. 

Another big misconception is that many people may perceive the Explanation of Benefits (EOB) as their total cost. 

“When you receive your explanation of benefits, that’s not a bill. Do not take that as your bill. You will later receive your bill after you have filed with your insurance company,” stated Harmon.

Regardless, Concho Valley ER believes that House Bill 2041 won’t affect them because they have been following the laws.

“We’ve always been in compliance with this, all ERs are supposed to anyhow,” added Dr. Speck.

 

Laws ERs are to abide by include the Emergency Medical Treatment and Labor Act (EMTALA), that requires anyone who goes to an emergency department to be stabilized and treated, regardless of their economic situation.

Freestanding emergency rooms are higher in price than urgent care and primary care clinics, therefore it is required for them to advertise themselves clearly to the public as one.

“You are going to sign several pieces of paper that state that we are an emergency room, when you come in and that we do bill accordingly,” claimed Harmon.

The doctors have an important duty to deem a patient as emergent or non-emergent.

If one is considered emergent (requiring emergency care), they should stay in the emergency center.

If a patient is non-emergent (requiring non-emergency care), they have more options.

“If you’re non-emergent, we’ll possibly send you to an urgent care facility if you would benefit more from that, but if you want to stay here, that is your option. We refer people to Shannon and Community all the time but it’s just knowing the difference between us and them,” detailed Harmon.

“We don’t want to penalize anybody for feeling sick, hurting or thinking they have an emergency. We want people to come in and get treated. We are more than willing to work with people to explain their benefits and the difference between the explanation of benefits and their actual cost. We frequently set up payment plans, and we write off a significant amount of money just as bad debt because we know that taking care of our community and our patients is more important,” expressed Dr. Speck. 



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