When a patient is suffering a medical emergency the last thing on their mind is how the bill is going to be handled during their visit to an urgent care center, freestanding ER or hospital emergency room. That’s why it’s important for them to do research ahead of time and know of their options, especially, when the patient has a government insurance plan. This is not always possible, however, and could leave some patients with government insurance plans confused or having to pay more out of pocket when faced with a medical emergency.
As medical billing consultants, we can help navigate how these cases should be handled to help ease or even halt any unexpected surprises to the patient after their visit has concluded. This article will help explain the three main types of government insurance plans and how they impact Texas medical billing services for emergency and urgent care.
Three Main Types of Government Insurance Plans
1. Medicare/Medicare HMO: is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD). Medicare beneficiaries will either have traditional Medicare or a Medicare HMO plan. They may also have a supplemental commercial plan to assist with any out of pocket expenses.
2. Medicaid is a healthcare program that assists low-income families or individuals in paying for long-term medical and custodial care costs. Medicaid is a joint program, funded primarily by the federal government and run at the state level, where coverage may vary. Medicaid plans in the state of Texas include Texas Medicaid, Texas Star, Star Plus, and CHIPS. This is not all-inclusive, but these are the most common plans.
3. Tricare (styled TRICARE), formerly known as the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS), is a healthcare program of the United States Department of Defense Military Health System. The most common plans are Tricare Standard, Tricare Prime, and Reserve Select.
Helping You to Navigate Government Insurance Plans in Texas Urgent Care and Emergency Room Facilities
While there are different reasons and benefits for a patient to choose to be treated at an urgent care facility, freestanding ER, or micro-hospital we can help with the medical billing solutions for any of these settings. Please contact us for a free medical consultation to see what 360 Medical Billing Solutions can offer.
By Amber Pratt, Client Representative, 360 Medical Billing Solutions