Insurance information

he Public Health Service Act, amended in 2021 with an effective date of  January 1, 2022 requires health care providers and facilities to post a notice of the following:

You  shielded from balance billing under the following circumstances:

Emergency Services:
⦁ In the event of an emergency medical condition and the receipt of emergency services from an out-of-network provider or facility, your financial responsibility  capped at your plan’s in-network cost-sharing amount (e.g., copayments, coinsurance). Balance billing for emergency services prohibited.
⦁ This protection extends to services received post-stabilization unless you provide written consent to waive these protections against balance billing.

Certain Services at In-Network Facilities:
⦁ When obtaining services at an in-network hospital or ambulatory surgical center, some providers may be out-of-network. However, they  limited to billing you the in-network cost-sharing amount designated by your plan.
⦁ This applies to specific services such as emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers cannot engage in balance billing or request you to waive your protection against it.
⦁ For other services received at in-network facilities, out-of-network providers cannot issue balance bills without your written consent to relinquish these protections.

It’s important to note that you are never obliged to waive your protection against balance billing, nor are you compelled to seek care out-of-network. You have the freedom to select providers or facilities within your plan’s network.

Additional protections when balance billing  prohibited include:

⦁ Responsibility limited to your share of costs (copayments, coinsurance, deductibles) as if the provider or facility were in-network.
⦁ Direct payment by your health plan to out-of-network providers and facilities.
⦁ Coverage of emergency services without prior authorization.
⦁ Inclusion of amounts paid for emergency or out-of-network services toward your deductible and out-of-pocket limit.

For further details, please refer to the full disclosure. If you believe you have received an erroneous bill, please contact Er of fort worth ‘s billing team at 832-273-1603 or the Federal No Surprises Helpdesk at 832-273-1603

Texas Senate Bill 425, enacted during the 84th Regular Session of the Texas Legislature