No Surprise Billing for Emergency Care
Federal and Texas laws protect you from surprise medical bills when you receive emergency care at Mesquite ER. Regardless of our network status with your insurance plan, you pay only your standard in-network costs: your copay, coinsurance, and deductible. We work directly with your insurance company to resolve any billing matters, keeping you out of the process entirely.
Why Network Status Doesn't Affect Your Emergency Care Costs
Your health insurance plan may list Mesquite ER as out-of-network. However, when it comes to emergency care, this classification has no impact on what you pay.
The No Surprises Act and Texas Senate Bill 1264 require insurance companies to process emergency visits at in-network rates, no matter where you receive care. Whether you visit our facility, a hospital ER, or another licensed emergency center, your out-of-pocket costs remain the same.
These laws ensure that:
- Your cost-sharing is limited to in-network amounts only
- Emergency care payments apply to your in-network deductible and out-of-pocket maximum
- Insurance companies cannot require prior authorization for emergency services
- No one can ask you to give up these protections as a condition of treatment
In a medical emergency, your priority should be getting care—not researching which facilities are in your network. These protections exist so you can focus on your health without worrying about unexpected costs.
Understanding Balance Billing
Balance billing occurs when a healthcare provider charges you the difference between their fees and the amount your insurance company pays.
Consider this scenario:
An emergency room visit results in charges of $1,000. Your insurance company determines the allowed amount is $600 and pays that sum. In the past, the provider could bill you for the remaining $400—on top of your regular copay and deductible. This extra charge, arriving weeks later, was the “surprise” in surprise billing.
Under current law:
Balance billing for emergency care is prohibited. You’re responsible only for your in-network cost-sharing. Using the same example, you would pay your standard copay and deductible, nothing more. The $400 gap becomes a matter between the provider and insurer—it never appears on your bill.
Legal Protections That Work for You
Two layers of protection shield you from surprise emergency bills: federal law and Texas state law.
Federal Protection: The No Surprises Act
Since January 1, 2022, the No Surprises Act has protected patients with private health insurance nationwide. For emergency services, this law establishes that:
- + Providers and facilities may only charge your in-network cost-sharing amount
- + Your insurer must process emergency claims without requiring advance approval
- + All payments you make count toward your in-network deductible and annual maximum
- + Your right to these protections cannot be waived
Coverage extends to employer-sponsored plans, marketplace plans, and most other private insurance arrangements.
Texas Protection: Senate Bill 1264
Texas implemented surprise billing protections ahead of the federal law. Effective September 1, 2019, SB 1264 shields patients with state-regulated insurance plans from balance billing. The law covers emergency services at any licensed facility and care from out-of-network providers at in-network facilities.
Together, these laws create comprehensive protection. You pay only your in-network share for emergency care, providers cannot bill you for the difference, and your protections cannot be taken away.
Your Cost Responsibility
Emergency care at Mesquite ER follows the same cost structure as any in-network emergency room visit:
Copayment: A fixed dollar amount your plan assigns to ER visits.
Coinsurance: The percentage of costs you pay after satisfying your deductible.
Deductible: The amount you pay before your insurance begins covering expenses. What you pay here counts toward your in-network deductible.
Out-of-Pocket Maximum: The annual limit on your cost-sharing. Once reached, your insurance covers 100% of eligible expenses. Payments at our facility count toward this limit.
After your insurance processes the claim, you’ll receive an Explanation of Benefits showing your responsibility at in-network rates.
Our Role in Handling Your Claim
We manage the insurance process so you can concentrate on getting better.
- During registration: We collect your insurance information and any applicable copay
- Following your visit: Our billing team submits claims to your insurance company.
- Once processed: Your insurer calculates your cost-sharing at in-network rates and sends you an Explanation of Benefits
- If questions arise: We handle disputes with your insurance company directly. You won't be asked to intervene or pay contested amounts during the resolution process
How Your Bill Is Structured
Emergency care typically involves two types of charges:
- Facility charges encompass the emergency room environment: nursing staff, medical equipment, supplies, administered medications, and the operational costs of maintaining 24/7 emergency readiness
- Physician charges reflect the professional services of the emergency physician who evaluated and treated you
These may appear as separate items on a single statement or arrive as two distinct bills. Balance billing protections apply to both categories for emergency services.
Options for Uninsured and Self-Pay Patients
The balance billing protections outlined above apply specifically to insured patients. If you don’t have health insurance or prefer not to use your coverage, different options are available.
ER of Mesquite offers flexible payment plans designed for self-pay patients. Monthly payments start as low as $15-$50, and 90% of applicants are approved. The application takes about 30 seconds and uses a soft credit check that won’t affect your credit score.
Our goal is to make emergency care accessible regardless of your insurance situation.
Additional Resources
For more information about your rights under Texas law, visit the Texas Department of Insurance at tdi.texas.gov/medical-billing/surprise-balance-billing.
For more information about your rights under federal law, call 1-800-985-3059 or visit cms.gov/nosurprises.
Billing Questions?
Our billing team is available to clarify charges, confirm insurance processing, and explore payment options.
ER of Mesquite Billing Department
Phone: (817) 785-8000
Email: info@aimbillingsolutions.com