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 ER treatment. 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.