No Surprise Billing for Emergency Care
You’re fully protected from surprise medical bills when you visit the ER of Dallas for emergency care.
Federal and Texas laws guarantee that you pay only your standard in-network costs—your copay, coinsurance, and deductible—regardless of our network status with your insurance plan. Any billing disputes are handled directly between your insurance company and us. You stay out of the middle.
Your In-Network Benefits at Our Facility
ER of Dallas may be out-of-network with your health insurance plan. But for emergency care, that distinction doesn’t change what you pay. Under the No Surprises Act and Texas Senate Bill 1264, emergency services at any licensed facility must be covered at in-network rates. Your insurance company cannot charge you more simply because you came to us instead of a hospital ER. The law requires them to treat your visit the same way they would treat an in-network emergency room visit. This means:
● You pay only your in-network cost-sharing amounts
● Your payments count toward your in-network deductible and out-of-pocket maximum
● Your insurance covers emergency care without requiring prior authorization
● You cannot be asked to waive these protections as a condition of receiving care
When you’re facing a medical emergency, you shouldn’t have to worry about which facility is “in-network.” You need care. We provide it. The law ensures you’re protected financially
What Is Balance Billing?
Balance billing occurs when a healthcare provider bills you for the difference between their charges and what your insurance pays.
Here’s how it used to work:
A provider charges $1,000 for emergency services. Your insurance considers $600 to be the “allowed amount” and pays that. Without protection, the provider could send you a bill for the remaining $400. That $400 “balance bill” came on top of your regular copay and deductible, often as a surprise weeks after your visit.
Here’s how it works now:
For emergency care, balance billing is prohibited. You pay only your in-network cost-sharing amount. In the example above, you’d pay your normal copay and deductible. The $400 difference? That’s between us and your insurance company, not your responsibility.
This protection applies whether you come to ER of Dallas, a hospital emergency room, or any other licensed emergency facility
How Federal and Texas Law Protect You
Two laws work together to protect you from surprise medical bills: the federal No Surprises Act and Texas Senate Bill 1264.
Effective January 1, 2022, the No Surprises Act protects patients with private health insurance from balance billing for emergency services. Under this law:
- Out-of-network providers and facilities can only bill you your plan’s in-network cost-sharing amount for emergency care
- Your health plan must cover emergency services without prior authorization
- Your health plan must count your emergency care payments toward your in-network deductible and out-of-pocket limit
- You cannot be required to give up these protections
These protections apply to most private health insurance plans, including employer-sponsored coverage and individual marketplace plans.
Texas enacted balance billing protections before the federal law took effect. SB 1264, effective September 1, 2019, provides similar protections for patients with state-regulated insurance plans. The law prohibits surprise billing for:
- Emergency care at any licensed facility
- Out-of-network providers at in-network facilities
- Diagnostic imaging and laboratory services are connected to care from a network provider
If your insurance card shows “TDI” or “DOI,” Texas law applies to your plan. If your coverage is through a self-funded employer plan, the federal No Surprises Act provides your protection.
What Both Laws Guarantee
Regardless of which law applies to your insurance:
● You pay only in-network cost-sharing for emergency services
● Providers cannot balance bill you for emergency care
● You cannot be asked to waive your protections
● Your emergency care payments count toward your in-network deductible
What You'll Actually Pay
When you receive emergency care at ER of Dallas, you’re responsible only for what you’d pay at any in-network emergency room:
● Copayment: The fixed amount your plan charges for an ER visit.
● Coinsurance: Your percentage of the cost after meeting your deductible (commonly 10-30%).
● Deductible: The amount you pay before insurance begins covering costs. Emergency care payments at our facility count toward your in-network deductible.
● Out-of-Pocket Maximum: Once you reach your plan’s limit, insurance covers 100% of covered services. Payments at ER of Dallas count toward this limit.
Your insurance company will process your claim and send you an Explanation of Benefits (EOB) showing exactly what you owe. This EOB will reflect in-network cost-sharing amounts, not out-of-network rates.
Understanding Your Emergency Room Bill
Emergency room visits typically generate two categories of charges:
- Facility charges cover the emergency room itself: nursing care, medical equipment, supplies, medications administered during your visit, and the infrastructure required to keep emergency services available 24/7.
- Physician charges cover the emergency physician's professional services for evaluating, diagnosing, and treating your condition.
Depending on how our physicians are contracted, you may see these as separate line items on one statement or as two separate statements. Both categories are subject to balance billing protections for emergency services.
Additionally, certain specialty services, including emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, and intensivist services, are specifically protected. Providers of these services cannot balance bill you and cannot ask you to waive your protections.
If You Believe You've Been Wrongly Billed
If you receive a bill that appears to violate your balance billing protections, start by contacting our billing department. Many billing questions result from timing differences between when claims are processed and when statements are generated. We can review your account and clarify charges.
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, visit cms.gov/nosurprises .
For Uninsured or Self-Pay Patients
The balance billing protections described on this page apply specifically to patients with health insurance coverage.
If you don’t have insurance or choose not to use your insurance, different options are available to you. ER of Dallas partners with Sunbit to offer flexible payment plans for self-pay patients, with monthly payments as low as $15-$50 and a 90% approval rate.
Under the No Surprises Act, uninsured patients also have the right to receive a Good Faith Estimate of expected charges before scheduled services. For emergency care, advance estimates aren’t always possible, but our billing team can discuss costs and payment options with you.
Questions About Your Bill?
Our billing department can explain charges, verify insurance processing, and discuss payment options.
ER of Dallas Billing Department
Phone: (817) 785-8000
Email: info@aimbillingsolutions.com
For general questions about your emergency care or medical records, contact the ER of Dallas directly at (214) 613-6694.