insurance

Wait Times, Insurance and COVID-19 Rapid Testing
Wait Times, Insurance and COVID-19 Rapid Testing 1024 768 Neal

During the spike of COVID-19 cases in North Texas, Frontline ER is experiencing a considerable increase in patients requesting COVID-19 testing.

We have more requests for COVID-19 testing than we can see in one day, so there is a waiting time.  We are able to see 100 insurance patients in a 24-hour period.  With most of the volume during the daytime hours, this requires us pausing our service to avoid people waiting 4 and 5 hours for testing.  Open 24 hours a day, a late night visit would minimize your wait.

However, we do offer the rapid test which means you will get your results during your visit.

Please keep the following in mind when you use your insurance:

Insurance.  While insurance is offering no copay on the actual COVID-19 test, Frontline ER is adhering to CDC guidelines for testing as qualification:

  • Exposure.  We test patients who have been exposed and waited 5 to 7 days after exposure to test.  The incubation time for the virus is different for each individual.  You may test today and be negative, but could be positive in 2 to 3 days.  Your insurance may not pay for multiple tests.
  • Symptomatic.  Patients with severe symptoms, such as shortness of breath, high fever, or fatigues, should be tested.
  • Medically Necessary.  Additionally, some claims are being rejected by some insurances because they are not deemed “medically necessary.” Exposure or symptoms, as stated above, are deemed medically necessary.
  • Multiple Tests.  If you have tested more than twice at Frontline ER, and your insurance has not paid, we may not be able to accept your insurance.
    • Tests for travel and retesting for work are not deemed medically necessary.
    • If your employer has requested a negative test for returning to work, please see the CDC Guidelines.

Wait Times.  With the growth in cases, so has demand for testing and, consequently, waiting for testing.  Consider these facts as you look for testing:

  • Frontline ER is an emergency room first.  That means we see any emergency patient first.  This may delay wait times for those using insurance.
  • If a patient tests positive, the room is sanitized with UV lighting for 30 minutes to protect our staff and future patients.

We have no control over these circumstances, so your estimated wait time may increase.

Thank you for your ongoing understanding and patience in these unprecedented times.  The health and safety of you and your family are always top of mind for us at Frontline ER.

Your EOB and Your Frontline ER Invoice
Your EOB and Your Frontline ER Invoice 1022 1024 Neal

After you’ve been treated at Frontline ER, we will submit your medical claim to your insurance company. Once the claim has been reviewed, you will receive an explanation of benefits (EOB) from your insurer. That is how the process for payment begins.

Please understand that an EOB is not a bill.

The EOB provides details about your medical insurance claim that has been processed and explains what portion was paid to Frontline ER (by the insurer) and what portion of the payment, if any, is the patient’s (your) responsibility.  You will also receive two bills regarding your Frontline ER visit:

  1. Facility bill.  This includes the use of the ER, medications administered, labs, imaging and supplies.
  2. Physicians bill.  This outlines the the physician’s charges for treatment.

Once you receive your Frontline ER invoices and you think you have been charged in error or do not understand the charges, please contact us.  We will be happy to speak with you and ensure that all the proper adjustments have been made.

Please contact us should you have any questions or concerns.  Thank you for being our valued patient and client.

Understanding Your Health Insurance
Understanding Your Health Insurance 300 245 Neal

There is a lot to learn about health insurance, and these definitions may help you understand your health plan.   Please understand that your benefits are established by your insurance company, not the medical facility.

Copayment is a fixed amount set by your health insurance paid to your providers.  The copay is due at the time of service. Examples of copays:

  • An emergency room copay might be $150.
  • A physician office visit, $25.
  • Prescription medication, $10.

Deductible is a fixed amount that you pay out of pocket each year before your health insurance begins to pay for medical services. If you have not met your annual deductible (expenses accured between January  to December of the year), you are responsible for medical charges until it is reached. Sometimes the insurance company applies something towards the patient’s deductible and sometimes it does not.

Coinsurance is the amount that you pay for covered medical services after you’ve satisfied your deductible. Coinsurance is typically expressed as a percentage of the charge for a service rendered by a healthcare provider. For example, if your insurance company covers 80% of the allowable charge for a specific service, you may be required to cover the remaining 20% as coinsurance. The coinsurance will apply first then the Out of Pocket amount will apply after.

Maximum Out-Of-Pocket Costs.  These are the annual limit for which patients are responsible under a health insurance plan. This limit does not apply to premiums, charges from out-of-network health care providers or services that are not covered by the plan. These charges happen when the deductible limit is met first and then the out-of-pocket limit is met. Once the annual limit is fully met by the patient’s plan, then the insurance will cover 100 percent of the allowed amount on the claim. This means no more copayments, deductible or coinsurance amounts to pay once the out-of-pocket annual limit is met.

Covered Services are what your plan will pay for completely or in part. Your health plan does not have to cover every service. The plan may only pay for a certain number of some services. Call the insurance company to see what services are covered. If a service you need is not covered, you should talk to your service coordinator before getting the service.

Prior Authorization means the emergency room does not need prior authorization.  Some plans require prior authorization (or prior approval) before certain services are provided. The doctor provides information to the plan to request the authorization. If the plan does not authorize the service, the insurance company will not pay for the service.

In Network.  Texas Senate Bill 425 ensures that a licensed emergency room does not need to be “in-network.”  That is, part of your insurance company network.

Appealing: You cannot appeal if the service was not covered by the plan or if you received more than the amount of services allowed.   If the insurance company still denies payment, you may be able to have an independent review organization (IRO) look at the denial. An IRO is an independent third party certified by the Texas Department of Insurance (TDI) (www.tdi.texas.gov/pubs/consumer/cb005.html).

Should you have any further questions or need clarification on your Frontline ER invoice, please contact us.

Frontline ER Dallas Clarifies Its COVID-19 Testing Payment Policies
Frontline ER Dallas Clarifies Its COVID-19 Testing Payment Policies 1024 684 Neal

Frontline ER Dallas is pleased to able to offer COVID-19 Antigen testing with results provided during your visit.  However, as of October, 24, 2020, payment policies have changed with regard to insurance and out-of-pocket payments.

Insurance. Insurance companies have announced varying deadlines regarding the “cost share” of payments for COVID-19 testing.  Frontline ER has established the following requirements for patients using their insurance:

  • A copay will apply to your ER visit for COVID-19 testing.
  • Patients must wait at least five days before testing after initial exposure.
  • A patient must exhibit symptoms within the last ten days.

Out of Pocket or Self Pay. For patients paying for the test themselves, Frontline ER offers quick registration and drive-thru testing paying by cash, credit or debit.  However, we do not provide insurance paperwork to file on your insurance.  We are also unable to provide billing codes or receipts for insurance.

Travel.  Testing for travel is self pay only (the fee).  We only offer the Antigen COVID-19 test with results during your visit.   We do not offer the molecular PCR test at this time.  It is the responsibility of the traveler to determine which test is required for their specific travel needs.

Frontline ER is a state-of-the-art freestanding emergency center providing diagnostics and treatment for patients 24/7.  Equipped to provide pediatric and trauma emergency care as well as treatment of workplace and household injuries, Frontline ER has locations in Dallas and Richmond, Texas.   Frontline ER has served the Lakewood neighborhood of Dallas since 2018.