Addressing What Matters

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Freestanding Emergency Rooms in Texas

One of the most important things we do at Blue Cross and Blue Shield of Texas (BCBSTX) is make sure our members have access to quality care when they need it by creating networks of outstanding hospitals and doctors. If a health issue is life threatening, members should call 911 or go to the nearest emergency room (ER).

If it’s not an emergency, we encourage our members to consider alternatives that could lower their costs. Part of that means making sure our members understand who offers what type of care to avoid unexpected out-of-pocket costs and “surprise” balance billing for out-of-network services.

Freestanding emergency rooms (FSERs) are the biggest reason Texas has one of the highest rates of balance billing in the nation. Balance billing means that anytime a member uses a facility that is not in their network, in a non-emergency situation, they may have to pay the cost difference (or balance remaining) of services.

These facilities can charge up to 10 times more than urgent care centers for the same services. In many cases, consumers are left confused and angry when they get a big bill for care they thought was covered.

More than 80% of the state’s out-of-network emergency claims occur at FSERs. In many cases, FSERs may choose not to be in an insurer’s network and therefore be “out of network” for insured patients. To add to the confusion, they may advertise that they take all insurance, or misstate emergency care coverage. However, FSERs are not prevented from balance billing members.

This is why we encourage our members to know about potential costs for different types of care, because where you go for care matters.

How Do You Know It’s a Freestanding ER?

Consumers often confuse FSERs for urgent care centers and can be unaware that the facility and doctor who sees them are considered out of network.

The location and look of FSERs can be similar to an urgent care center. However, the price of care may be as much or more than a hospital would charge for emergency care. Many of these facilities are not owned or run by in-network hospitals.

This often leads to two separate balance bills for care received at an FSER: one balance bill for the facility and one from the doctor who treated the patient. Additionally, all FSERs charge a separate “facility fee,” which urgent care centers don’t charge.

Key indicators that a facility is a FSER include:

  • Have the word “Emergency” in their name or on the building
  • Are not attached to and may not be affiliated with a hospital
  • Bill separately for the ER and the doctor, even if the care you need is minor

Increasing Transparency With SmartER CareSM Options

To increase transparency and make sure our members are more informed, we are reaching out to members in Texas through:

  • Emails about where to go for care and making sure they know about our SmartER Care resources.
  • Updates to our SmartER Care website, including interactive resources to help members identify and compare affordable care options, including:
    • Additional information on how Virtual Visits can offer support to members 24/7
    • How Blue Access for MembersSM allows members to compare costs before going for care
    • Online and text resources that help members locate the in-network urgent care center closest to them

BCBSTX is committed to making sure our members get the care they need while also being good stewards of their premium dollars. We also ask that our members join us in tackling this challenge.

Resources Available to Find an In-Network Provider

We’re here to support you. Our suite of digital tools and resources — such as Provider Finder®, Virtual Visits, Member Rewards and our Benefits Value Advisor — are available to help you make informed health care decisions.

  • Our Provider Finder site and app are available to help you make informed health care decisions, and find an in-network provider.
  • Your coverage may also include virtual visits, which provide access to doctors and therapists by mobile app, online video or phone.
  • Registered nurses are on call to answer member questions and concerns through our 24/7 Bilingual Nurse Line at 800-581-0353.

We encourage all members to use the benefits that are included with their plan by checking their benefits book for details. Members can also call the Customer Service number on the back of their member ID card for more information.

Advocating for Policies to Protect Our Members

BCBSTX is committed to making the health care system work. The following new reforms demonstrate solid progress in protecting our members and all Texas health care consumers. It’s part of the work BCBSTX has been doing for 90 years to provide our members access to quality, cost-effective health care. Our members and indeed, Texans, should not expect, nor accept, anything less.

In 2015, the Texas Legislature adopted SB 425, which requires all FSERs to clearly disclose the following information:

  • The facility is an FSER
  • The facility charges rates compare to a hospital ER and may also charge a facility fee
  • A doctor that provides care at the facility may not be in the patient’s health plan network
  • A doctor providing care at the facility may bill separately from the facility

A law enacted in 2017 allows PPO members to seek mediation for surprise bills from any out-of-network emergency provider, including FSERs and out-of-network clinicians who provide care at in-network facilities.

  • SB 507 Learn more about third-party links Expands mediation to more out-of-network emergency care providers who balance bill, including FSERs and ER facilities; and to all non-network, facility-based providers at network hospitals.
  • This protection also expands disclosure requirements for health plan Explanation of Benefits and providers bills.

Another law enacted in 2017 requires independent FSERs to explicitly inform patients whether they’re in a health plan’s network.

  • HB 3276 states a FSER must post a notice that either lists the health plans for which it is in-network or state that it does not participate in any health plan.

While these recent reforms represent progress in protecting health care consumers in Texas, still more work needs to be done. Currently, mediation is not available for all consumers or for all emergency services. Also, mediation provides valuable patient protections but does not address the underlying economics causing most balance billing, and despite efforts to inform members, consumers are still confused by FSERs.

We will continue to work with our industry partners and organizations, including the Texas Association of Health Plans Learn more about third-party links, to work with policymakers and make sure our members in Texas are prepared to make SmartER Care choices in 2018.

Third-Party Resources