Prestige ER Insurance Information
Texas Department of State Health Services
Per Senate Bill 425, which took effect September 1, 2015, House Bill 3276, which took effect September 1, 2017, and House Bill 2041, which took effect September 1, 2019, and relates to health care information provided by and notice of fees charge by Freestanding Emergency Medical Care facility, we are required to post a sign stating:
This is a freestanding emergency medical care facility.
This facility charges rates comparable to a hospital emergency room and may charge a facility fee provider network.
This facility or a physician providing medical care may be an out of network provider for the patient’s health benefit plan.
The physician providing medical care at the facility may bill separately from the facility for the medical care provided to a patient.
This facility is an out of network provider for all health benefit plans.
The Law Guarantees Coverage
For all cases deemed emergent, Texas state law requires your insurance company to pay for your emergency care, even if the emergency room is classified as out-of-network. The state of Texas empowers patients to use a standard called the prudent layperson standard when determining what constitutes an emergency.
If your insurance provider is refusing to reimburse you for your emergency room visit, you can file a complaint with the Texas Department of Insurance (TlDI). For more information about this process visit the Texas Department of Insurance.
Prudent Layperson Standard
In 1997, Congress enacted the Prudent Layperson Standard which states:
The term “emergency medical condition” means a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that a prudent layperson, who possesses an average knowledge of health and medicine, could reasonably expect the absence of immediate medical attention to result in:
- Placing the health of the individual (or, in the case of a pregnant woman, the health of the woman or her unborn child) in serious jeopardy,
- Serious impairment to bodily functions, or
- Severe dysfunction of any bodily organ or part
- Serious disfigurement
The Prudent Layperson Standard was explicitly drafted to ensure patients receive the emergency medical services they need when they need it. If you have a question about the medical billing process or need any assistance processing your insurance claims, please feel free to contact our facility administrators: