Billing and Insurance
Thank you for choosing Tucson ER & Hospital for your emergency medical care. To better serve you, we want to make the billing process simple and transparent. We understand that some patients may find the billing process confusing or overwhelming. We want to help you understand your bill. Your bill may be different from other medical bills you may have received from hospitals or physicians. It’s important to note that Tucson ER & Hospital is a freestanding micro-hospital.
Cash Payments
If you do not have insurance, we do accept cash payments for visits. How much you are charged will depend on what’s needed during your visit. This will be discussed with you prior to your treatment so that you are aware of any charges. Once you pay your bill for your services, there will be no additional bills in the mail following your visit. We make this very transparent and easy for our patients.
Insurance
Tucson ER & Hospital accepts private/commercial insurance plans. We also accept out-of-pocket payments in the form of cash, checks or credit cards.
Due to current federal legislation, we are unable to accept Medicare or Medicare related plans, Medicaid, AHCCCS or TRICARE.
Worker’s Comp
Important Information Regarding Insurance
*At Tucson ER & Hospital we are unable to accept any Medicare, Medicaid (AHCCCS) or TRICARE plans. While we want to treat all the patients in our community, since we are a physician owned Hospital & ER, the Affordable Care Act restricts us from getting contracts with these payors. That being said, any patient presenting to our ER will be evaluated for a medical emergency regardless of their insurance status.
In an effort to protect patients, the federal government issued the Federal No Surprises Act (NSA). The NSA addresses several different points. The most notable point is the NSA serves to prohibit surprise billing. A surprise medical bill is an unexpected bill, often for services received from a healthcare provider or facility, that a patient may not have known was out-of-network with their insurance until a bill is received. Simply stated, an out-of-network provider cannot send a bill to a patient for any amount outside of their yearly in-network deductible and co-insurance. This does not apply to amounts paid directly to patients by their insurance provider for services rendered rather than paid to the provider. In those cases, a patient may receive a bill for full charges until the insurance payment amount is provided or paid over to the appropriate facility by the patient.
The Federal No Surprises Act was issued after lawmakers passed a law to base emergency services payments on local median in-network rates, also known as QPAs, instead of usual and customary rates. The law enacted a system where insurers and providers negotiate the correct amount to be paid. Once in agreement, the bill can be settled through an independent dispute resolution process. Insurers must now disclose how they come to the QPA-median in-network price and if they down-coded the claim for any reason.
Our Billing Policy
Tucson ER & Hospital accepts private insurance plans. We also accept out-of-pocket payment in the form of cash, checks or credit cards.
Your ER co-pay will be collected at the time of your visit. We will then bill your insurance company for the policy’s emergency room benefits. There will be two different claims mailed to your insurance company: the facility bill and the physician bill. If you have any questions concerning your bill please contact our Billing Department at 713-357-2535.
Insurance Benefits
If you have health insurance, you will receive an Explanation of Benefits (EOB) from your insurance company in the mail. Taking the time to be familiar with your benefits will help you make the best decisions when seeking medical care. It is important to note that the EOB is not a bill.
Tucson ER & Hospital is classified as out-of-network with many insurance companies; however, Tucson ER & Hospital does honor all in-network deductibles and benefits.
Are We "In-Network"?
For all cases deemed emergent, 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 Arizona empowers patients to use a standard called the prudent layperson standard when determining what constitutes as an emergency. A ‘prudent layperson’ is defined as a person without medical training who exercises those qualities of attention, knowledge, intelligence and judgment which society requires of its members for the protection of their own interest and the interests of others.
How Does Worker's Comp Work?
Workers’ compensation is a state-funded insurance program that gives covered employees income and medical benefits if they’re injured while working. Under Arizona law, it is mandatory for employers to secure workers’ compensation insurance for their employees. Workers’ Compensation is a “no-fault” system in which you receive medical and compensation benefits no matter who caused the job-related incident.
Workers’ compensation pays medical bills and is covered underneath the Arizona Workers Compensation Law (Title 23, Chapter 6).
For more information on workers’ compensation, visit the State of Arizona’s Risk Management page at https://staterisk.az.gov/
If you’d like to file or dispute a claim, call 602-542-2182.
Where can I learn more about the No Surprises Act?
Visit CMS.gov/nosurprises, or call the Help Desk at 1-800-985-3059 for more information.
What if I have questions regarding a bill?
Contact the Patient Advocacy Department of Nutex Health at (713) 357-2535, Monday – Friday from 7:30 – 4:30 CST.
