There has been an increase in the number of facilities not located in a hospital that represent themselves as "Emergency Care" treatment centers. Because these facilities are not licensed by the state as emergency facilities, Blue Cross and Blue Shield of Texas has developed criteria that a facility must meet to be considered a non-hospital based emergency room facility.
You should be aware that if you seek emergency treatment at an emergency care center in a facility that is:
- Not located in a hospital, and
- Not in your network of contracted providers
You may incur additional expense.
The following is a summary of the BCBSTX criteria for a facility to be a free standing emergency care facility. Currently there are no free standing emergency facilities in Texas that meet this criteria.
- The Facility complies with Emergency Medical Treatment and Active Labor Act (EMTALA) applicable requirements (whether or not it is subject to EMTALA).
- The Facility must have and maintain appropriate standing arrangements for the transfer of the member to an acute care hospital with an emergency department if medically necessary.
- Physicians performing services at the Facility must have additional training in Emergency Medicine and/or be board certified in Emergency Medicine.
- The Facility must be open 24 hours a day, 7 days a week, with at least one emergency care qualified physician and one licensed nurse on duty at all times.
- The Facility must have and maintain equipment and supplies suitable for provision of emergency care services.
- The Facility must be accredited by one of the following programs:
- Joint Commission on the Accreditation of Healthcare Organizations (JCAHO)
- Accreditation Association for Ambulatory Health Care (AAAHC)
Please refer to the Provider Finder to verify the participation status of a provider. If you have any questions, please contact BCBSTX Customer Service at (800) 252-8039.
