Commercial Health Insurances are any type of health insurance plans that are not regulated by a government agency. The plans typically fall under three categories: group, individual, and personal. This article will help patients to understand their coverage and out of pocket costs for services in emergency rooms, freestanding ERs, and urgent care centers.
While there are several types of insurance plans, the two most common plans are the Health Maintenance Organization (HMO) and the Preferred Provider Organization (PPO). A Health Maintenance Organization (HMO) offer plans from a network of providers who have agreed to provide services to its members. With the majority of HMO plans, the member is required to select a primary care physician within this network.
A Preferred Provider Organization (PPO) offers health insurance plans which allow the member to visit any physician within the network without having to choose a primary care physician. It is important to choose providers or facilities within the network to be covered at the highest benefit level on your plan.
The most common commercial insurances available are Blue Cross Blue Shield, Aetna, United Healthcare, Cigna, and Humana. Urgent Care facilities. Hospitals and Free Standing Emergency Rooms accept most commercial insurances. However, they may not be covered by the patients in-network benefits if these facilities are not in the patient’s network. Typically a patient’s benefit plan explains what types of services they are covered for, what their out of pocket is, what their deductible is, and coverage for services in network vs. out of network. Their plan may also define what services are eligible for coverage in urgent care and emergency room facilities. All of this information determines claim benefits and what a patient is expected to pay out of pocket.
Patients need to read and understand their benefit plan. To maximize their claim benefits for urgent care and emergency room services, they should choose facilities that are within their network. They should not use emergency rooms and urgent care for primary care services. Treatment that is not urgent may be declined when the patient uses an urgent care facility or emergency room inappropriately for treatment.
How to Reduce Patient Confusion Related to Urgent Care and Emergency Room Medical Billing
While there are different types of treatment and coverage benefits when a patient is treated at an urgent care facility, freestanding ER, or hospital emergency room, 360 Medical Billing Solutions are specialists in helping to streamline office operations that reduce billing issues and increase revenues in episodic healthcare facilities.
We provide education and information to increase patients’ understanding of the medical billing process. Our methods help patients to make better choices that maximize insurance coverage and reduce confusion. Contact us for a free medical consultation to see what 360 Medical Billing Solutions can offer your emergency department and urgent care center.
By Susan Smith, Client Representative, 360 Medical Billing Solutions