Texas Law Covers You in Case of A Vehicle Accident
When traffic accidents happen, the last thing on your mind should be, can I afford care?
If you are involved in a car crash, know that both Federal and Texas laws protect your right to receive emergency care at any facility regardless of if it’s in or out-of-network.
Know You Have a Legal Right to Emergency Care Coverage at No Extra Cost
The Affordable Care Act medical insurance plans must provide these ten essential benefits:
- Outpatient ambulatory patient services
- Emergency Services
- Hospitalization including surgery and overnight stays
- Pregnancy, maternity, and newborn care (both before and after birth)
- Mental health and substance use disorder services, including behavioral health treatment, counseling, and psychotherapy
- Prescription drugs
- Rehabilitative and habilitative services and devices
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services, including oral and vision care
According to federal guidelines, during an emergency, including traffic accidents, patients have the right to receive medical care at the nearest ER that can provide adequate treatment.
Therefore, patients have the right to choose to receive emergency medical treatment at any facility regardless of its part of their insurance company’s network or not.
Moreover, insurance companies are obligated to provide the same coverage and rates when an out-of-network provider delivers emergency treatment to one of their customers.
It’s important to know that you DO NOT need to obtain prior approval from your insurer during a medical emergency.
The definition of a medical emergency is any illness, injury, symptom, or situation severe enough that a reasonable person would seek care right away to avoid serious or long-term harm.
Traffic Accidents in Texas
According to the most recent statistics by the Texas Department of Transportation:
- 3,893 people died in a motor vehicle traffic accidents in 2020
- 256,338 persons were injured in motor vehicle traffic accidents in 2019
- 1 person died every 2 hours 26 minutes from car-crash related injuries
- 1 person was injured in a traffic accident every 2 minutes 3 seconds
- 1 reportable car crash occurred every 56 seconds
- There were 12,897 crash-related severe injuries in Texas in 2019, with 15,843 people sustaining a serious or incapacitating injury
Insurance Companies Must Honor Your Coverage Benefits and Rates During a Medical Emergency
The law prohibits insurance companies from penalizing their customers for receiving emergency care at an out-of-network facility.
Therefore, your insurance provider cannot deny or limit your plan’s emergency services benefits or charge more in copays if you visit a provider outside of their network.
How Much Will You Pay for Out-Of-Network Emergency Services?
Coverage benefits vary from one plan to another. You will still be responsible for any deductible and coinsurance/copayments detailed in your insurance policy.
However, you don’t have to worry about paying more if your emergency care provider is out-of-network.
Reasons to Visit the ER if You Are Involved in a Traffic Accident
Suppose you or a loved one are involved in a traffic accident. In that case, it’s crucial to get evaluated by a medical professional as soon as possible, even if you think you are not seriously injured.
Reasons to Come To Prestige ER After a Traffic Accident
Serious Injuries May Not Be Apparent and Symptoms Might Not Manifest Immediately
Victims of trauma many times don’t realize the extent of their injuries. During traumatic experiences such as car crashes, the body releases an enormous amount of adrenaline.
Most of us know adrenaline as the fight or flight hormone. However, adrenaline has other functions, including blocking the pain receptors in our body.
Thanks to adrenaline, many car crash victims don’t realize they are badly hurt, and their lives could be in danger.
Additionally, internal injuries are not visible, and symptoms may not appear until much later. A timely medical evaluation can significantly reduce the risk of severe complications, long-term disability, and even death.
A Delayed ER Visit Could Affect Your Health Insurance Claim
Some insurance companies may deny emergency services coverage due to an accident if too much time has passed between the accident and the Emergency Room visit.
The more time passes between the accident and the emergency room visit, the more challenging it can be to prove a correlation between the injury and the accident.
If the patient and the emergency room staff cannot convince the insurance company that the accident caused the injuries or symptoms, it is more likely for insurance companies to deny claims.
At Prestige ER, our medical staff will fight for your life, and our Patient Advocate will always fight for your right to coverage.
Our Patient Advocate will file claims on behalf of patients and provide all pertinent documentation to prove there was a need for emergency services. This way, patients won’t have to pay more to receive quality care with minimal wait times.