Texas Regulations

Texas Regulations

Texas Regulations for Emergency Rooms

The Texas state mandate has set guidelines for insurance carriers which requires them to pay in-network benefits for members who receive treatment at an ER. Texas law demands that your insurance company covers emergency room treatment, whether the healthcare facility is considered out-of-network or not. Texas state law empowers you to utilize the prudent layperson standard when determining if your condition requires emergency medical assistance.

Insurance providers are required by law to reimburse covered patients who seek emergency care in Dallas at an ER. If you are having difficulty with your insurance provider and if they are refusing to pay for an ER visit, you are eligible to file a complaint with the Texas Dept. of Insurance. For information, Texas ER insurance coverage go online to http://www.tdi.state.tx.us.

Texas Senate Bill 425

Senate Bill 425, passed by the Texas Legislature during the 84th Regular Session, requires all FECs to post notice of the following:

  • This is a Freestanding Emergency Medical Care Facility
  • This facility charges rates comparable to a hospital Emergency Room and may charge a facility fee
  • This facility or physician providing medical care at this facility may not be a participating provider in your Health Benefit Plan provider network
  • A physician providing medical care at this facility may bill separately from the facility for the medical care provided to you