InsuranceWe understand that there can be a lot of questions about how to pay for your medical care. It can be stressful, confusing, and one of the major reasons people do not seek medical care. Here are some FAQs about our insurance policies. Contact us if you have questions.
ST. MICHAEL'S EMERGENCY ROOM TAKES YOUR INSURANCESt. Michael's Emergency Rooms are not "in network" for any insurance provider, but we accept all private insurance plans including Cigna, Blue Cross, United Healthcare and Aetna. We also accept more than 200 other plans. We do not accept Medicare or Tricare. What "accepting" these plans means to you: St. Michael's Emergency Rooms will file the insurance for you. You will not have to do the paperwork.
YOUR INSURANCE MUST PAY FOR AN ER VISIT WHETHER IT'S "IN NETWORK" OR "OUT OF NETWORK"It's the law: you must be reimbursed by your insurance carrier for your emergency room visit. Texas law requires your insurance carrier to pay for your emergency care, whether the emergency room is "in network" or "out of network." The state of Texas empowers you to use "a prudent lay person standard" in considering what constitutes an emergency. What this means: if you determine that your health or life or that of someone in your care has a medical condition serious enough to go to an emergency room, the most convenient emergency room is the right choice. If a patient determines that waiting hours in an emergency room to be seen by a doctor could compromise their health or life, an emergency room (such as St. Michael's) which offers a short wait time is the best choice. In other words, you as the patient are empowered to use your best judgment in choosing an emergency care facility, whether it's "in network" or "out of network" on your insurance plan.
WHAT IF MY INSURANCE CARRIER REFUSES TO PAY?State law requires patients to be reimbursed for emergency room visits by their insurance carrier. If your insurance company refuses payment for your emergency room visit, you can file a grievance with the Texas Department of Insurance. To learn more about the Texas Department of Insurance, please refer to their website: http://www.tdi.state.tx.us.
To contact the Texas Department of Insurance by phone or mail:
Texas Department of Insurance
333 Guadalupe, Austin 78701
P.O. Box 149104, Austin 78714
Consumer Help 1-800-252-3439
Report Fraud 1-888-327-881