Frequently Asked Questions about ER Physician Billing


How does the billing process work once I have received services?
As a convenience to our patients, we will first bill your insurance company directly for all services provided to you by the hospital if you have insurance. In most situations, your insurance carrier will pay the claim within 45 days of submission. The amount they pay will be based on the plan benefits, as described in your health plan. If your insurer does not pay within this time, we may ask your assistance in prompting their payment. Please note: Hospital charges are not included in your bill. You will be billed separately by the hospital, as well as any other physicians (radiologists, anesthesiologists, pathologists, etc.) who participated in your treatment.

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What is the normal billing cycle?
You will receive a bill if your insurer determines that a portion of the charge is the patient’s (your) responsibility. We typically send this bill within 5 days of receiving notice from the insurer of the patient’s responsibility for a potion of the bill. If you do not have health insurance, you should expect to receive a bill for the services you received within 15 days following your visit to the ER.

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How long will it take for my account to be resolved with my health plan?
Each insurance carrier is different, but we generally expect full payment from the health plan within 45 days of billing. If your insurance carrier has not paid the claim in this period of time, we may send you a notification of their nonpayment and ask your assistance by calling them to encourage prompt payment.

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How much will I owe?
Once we receive a payment or denial from your insurance carrier, we will send you a statement indicating the amount you owe. That total is due upon receipt. If you have questions, you should contact your insurance carrier or one of our Customer Service Representatives. If your insurance carrier fails to make any payment on your account, we may seek full payment from you.

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What are my payment options?
For your convenience, we accept a variety of payment alternatives, including VISA, MasterCard, Discover and personal checks. Additional payment options are available based on personal circumstance and will be coordinated on an individual basis. Please contact our Customer Service Representatives at (800) 378-4134 for assistance in identifying a viable solution.

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Is it possible to get a discount?
We realize that emergency care is typically not anticipated by a patient, and consequently, bills for medical treatment can be difficult to pay immediately. For this reason, we offer discounts based on financial hardship and uninsured status. However, because of the many state and national regulations associated with government-sponsored health insurance (Medicare and Medicaid), we are not able to waive a co-payment or deductible. We do, however, offer a variety of payment options, in addition to discounts, and will work with you to find the best alternative for your individual circumstance. Please contact our Customer Service Representatives at (800) 378-4134 for further information.

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How can I better understand my bill?
Healthcare charges are complex and include confusing clinical terminology. To simplify the information for you, we include an easy-to-understand summary of charges by category on all bills and statements. Should you have questions about your bill, please contact our Customer Service Representatives at (800) 378-4134.

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What if I don't have health insurance?
Our priority is to find payment alternatives that will work for you and will fully resolve your financial obligation. In addition to accepting cash, checks and most major credit cards, our Customer Service Representatives can work with you to develop an acceptable payment plan in appropriate circumstances. In addition, if you meet the criteria for financial hardship, some level of payment waiver may be available. Whatever the final agreement, however, you are expected to meet your financial obligation for services provided on a timely basis.

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What other bills can I expect to receive?
Hospital charges are not included in our emergency physician billings. Therefore, you will receive a separate bill from the hospital. If you received services from any other physician(s) at the hospital, you will receive a separate bill from them too. This may include radiologists, anesthesiologists, pathologists and others. Please note: Physicians who treated you may or may not be contracted with your health plan. Please contact those physicians directly for questions regarding their billings.

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I went to an in-network hospital. Why is the doctor out-of-network?
The hospital you visited does not employ some of the physicians who work there. Instead, those physicians are part of a group that contracts with the hospital. Because the hospital and the physicians are two separate groups, the groups may not be in-network with exactly the same health plans. The emergency physicians make every effort to contract with health plans. However, sometimes, a health plan will be unwilling to agree to pay the emergency physicians a reasonable rate for their services. Because of this, the physicians will not enter into an agreement with the health plan. Since being treated by out-of-network physicians can be costly, be sure to call your insurance company to determine the ERs where your network physicians practice. If your visit was truly an emergency situation, you likely will not have an opportunity to decide which facility to visit. If you do have a choice of ER facilities, knowing ahead of time where your network physicians work should save you money in the long run.

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I was only seen for 5 minutes, why am I being charged?
Just because a physician saw you for only a small amount of time, does not mean that that physician did not dedicate more time to your treatment by reviewing test results, evaluating your case history or visiting with another medical provider to determine the best treatment for your situation. Due to the complexity of medicine today, physicians perform much of their work away from the patient’s bedside.

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Why do my hospital bill and my emergency physician bill reflect different service levels? Shouldn’t they be the same?
Not necessarily. Hospitals evaluate medical treatment using a different set of standards than those used by emergency physicians. Hospital service levels, called “Evaluation and Management Codes”, are determined based on the technical aspects of the medical services provided to the patient. The physician’s Evaluation and Management Code is based on the personal, professional service rendered to the patient. Because the criteria used to determine the levels are different for hospitals and physicians, often, their service levels are different for the same patient visit.

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