Billing

Health Insurance, Payment Plans, Memberships, and Patient Advocacy Team

The Billing Process Is
Confusing, Let Us Help!

At Family Hospital Systems, we recognize that emergency medical expenses are never expected and healthcare benefit plans can be extremely difficult to understand and navigate. Our Patient Advocacy team is dedicated to make you feel comfortable raising questions and/or concerns about your recent visit, your insurance copay/deductible and/or your balance due with us. When you receive your bill(s), please call our Patient Advocacy Line (PAL) today for assistance.

The Billing Process

Understanding the lifecycle of a healthcare bill

State & Federal Laws

State and Federal laws require insurance companies to pay for emergency care regardless of whether it is obtained at an in-network or out-of-network facility. During your registration at Family Hospital Systems, we ask you to sign an “authorization” form which allows us to Negotiate and Appeal your claim with your insurance company for reimbursement on your behalf.

The Claim

We send your medical Claim to your insurance company. Once your insurance company receives the claim, they are supposed to respond within 15 days. They have 35 days to offer payment to settle.

Explanation Of Benefits

Approximately two weeks after your visit, you may receive an Explanation Of Benefits (EOB) Statement from your insurance company. Do not worry! This is not your bill so, Please disregard the section of the EOB statement that states “You may owe$ —-”

How We Deal With Undervalued Claims

If your insurance company has undervalued your claim, Family Hospital Systems will send an appeal to the insurance company asking them to reimburse at Fair Market Value. The insurance company then has up to 120 days to send additional reimbursement or a formal denial of additional payment. The insurance industry often will require 3 separate levels of appeals each taking up to 120 days. It is common for the appeals process to take up to a year. If the appeals process fails to encourage your insurance to properly value the claim, after we’ve exhausted the appeals process, Family Hospital Systems will send you a bill.

What Does the Bill Sent to You Mean?

Once we have exhausted the appeals process, Family Hospital Systems will send you a bill for the amount that your insurance company is asking you to pay for the claim. This is not a Balance Bill but instead is typically your coinsurance or deductible amount.

Still A Bill? Please Call Us!

In the event you receive a bill at the conclusion of this lengthy process, we highly recommend you call our Patient Advocacy Line (PAL)

(737) 787-7809

Billing Questions

We do not contract with private insurance companies but we will work with your insurance carrier for the services provided. If you do not have insurance, we have several financial assistance programs to make sure your care is affordable.

Healthcare terms are like a whole foreign language of its own.

  • Copay is a charge set by your health insurance plan for specific services. Your copay is due at the time of service and varies for different services. For example, a visit to your primary care doctor will be different than a visit to the emergency room or a specialist. Your copay amount is typically based upon your specific insurance plan.
  • Coinsurance is the amount you are responsible for after you have paid your copay and met your annual deductible. Coinsurance is typically done with a percentage of covered costs. After the deductible is met, your insurance will pay a percentage of the balance. Example; if your insurance pays 80% of the covered services, you are responsible for 20% of those charges.
  • Cost-sharing is the general term for any charges the patient is responsible for under the terms of their healthcare plan. This includes copayments, coinsurance and deductibles. Most healthcare plans include a maximum cost-sharing that sets an annual maximum out-of-pocket limit to the financial responsibility of the patient.  See your specific health plan for details.
  • Deductible is a set dollar amount that your insurance company requires you to pay out-of-pocket (yearly) before your insurance provides payment of claims. The amount of your deductible is based on your specific health plan.  Not all plans have a deductible.

We do our best to work with your insurance company for fair compensation for services provided. In order to be compliant with regulations we must charge one universal rate to all insurance companies for services we provide. 

To discuss your bill please call our patient advocacy line at: (737) 787-7809

If you are looking for alternative affordable options we encourage you to explore our healthcare memberships

Please review explanation of practices here: 

Standard Practices

NOTICE OF FEES
Family Hospital Systems LLC, would like to inform our patients of the
following:
(1) The facility is a freestanding emergency medical care facility;
(2) The facility charges rates comparable to a hospital emergency room and
may charge a facility fee;
(3) A facility or a physician providing medical care at the facility may be an outof-
network provider for the patient's health benefit plan provider network;
and a physician providing medical care at the facility may bill separately from
the facility for the medical care provided to a patient;
(4) The facility is an out-of-network provider for all health benefit plans.

Financing Partners

Even with health insurance, far too many people have difficulty paying for the care they need. The SmartHealth PayCard is uniquely designed for healthcare expenses, providing the freedom to make smart choices about treatment. Now you can focus on your health, not how to pay for it. Approved cardholders receive:

  • A revolving credit line up to $30,000* to cover high deductibles, co-pays, co-insurance, and prescription drugs
  • The ability to pay for routine doctor visits, mental health, dental, vision, medical equipment and supplies, cosmetic surgery, and more
  • Up to $5,000 of Accident Medical Expense Insurance**
    $5,000 Accidental Death Insurance**
    A national prescription savings program***
  • Discounts at participating providers, including surgical centers, imaging centers, pharmacies, and other medical-related entities
  • A complement to health savings accounts (HSAs)
  • Security and fraud protection
  • Access to a user-friendly website to view real-time transactions, keep track of healthcare expenditures, make payments, organize transactional healthcare records for bookkeeping and tax preparation

Apply Here

*depending on applicant’s creditworthiness** Plans are underwritten by United States Fire Insurance Company. This insurance provides limited benefits. It does not provide major medical or comprehensive medical coverage and is not designed to replace major medical insurance. By applying for and receiving the SmartHealth PayCard, the cardholder becomes a member of the Financial Solutions Association (FSA). Your coverage is under form BA-50000P-USF and issued to the FSA. It is subject to the terms, conditions, limitations and exclusions of the Policy. Any discrepancies between the certificate of insurance and the Policy will be governed by the Policy. See website for Certificate of Insurance. Accident Medical Expense Benefits Annual Maximum for All Accident Medical Expenses: $5,000 Maximum Number of Occurrences per Policy Year: 3 Lifetime Maximum: $100,000 Accidental Death Benefit Principal Sum: $5,000 Time period for loss is 90 days Age-Based Reductions at Age 65 or More: 15% of Principal Sum *** This prescription savings program is not health insurance, and is not affiliated with United States Fire Insurance Company. The prescription savings program can be used for pets’ prescriptions, if the medication is also available for human consumption.

Billing notice

The hospital is out-of-network for all benefit plans.

Hospital Notice Required by HB 2041

The facility is licensed as a Hospital under the provisions of Chapter 241, Health and Safety Code, and the Hospital Licensing Rules.

The facility charges rates comparable to other hospitals and may charge a facility fee for emergency room services.

The facility or physician providing services at the facility may be out-of-network with the patient’s health plan.

A physician(s) providing medical care at the facility may bill separately from the facility for the medical care provided to a patient.

The hospital is out-of-network for all benefit plans.

El hospital está fuera de la red para todos los planes de beneficios.

Aviso hospitalario requerido por HB 2041

La instalación tiene licencia como Hospital bajo las disposiciones del Capítulo 241, el Código de Salud y Seguridad, y las Reglas de Licencias Hospitalarias.

La instalación cobra tarifas comparables a otros hospitales y puede cobrar una tarifa de instalación por los servicios de sala de emergencias.

El centro o médico que presta servicios en el centro puede estar fuera de la red con el plan de salud del paciente.

Un médico que proporciona atención médica en el centro puede facturar por separado del centro para la atención médica proporcionada a un paciente.

El hospital está fuera de la red para todos los planes de beneficios.