Plan Ahead for Emergencies to Avoid a Higher Co-Pay

Posted on 9/19/17

As of Sept. 1, HealthSelect of Texas and HealthSelect Out-of-State plan participants pay a higher copay ($300 instead of $150) when they receive care at a non-network freestanding emergency room.

Please note: This change does not apply to Medicare Advantage or HMO plan participants.

The Legislature directed ERS to implement this higher copay along with several other cost-containment measures to lower overall plan costs. Most of the measures are behind the scenes, but this one requires HealthSelect participants to think ahead. Better to know now where to seek care during an emergency than to face figuring it out under stress. It’s a good idea to:

  • Use the HealthSelect provider finder to locate the nearest in-network hospital-affiliated emergency department, whether freestanding or attached to a hospital, where you could receive emergency care in life-threatening situations. You might have noticed freestanding ERs popping up in your area in the past few years. It’s important to know the know the difference between a freestanding emergency room and a freestanding emergency department. A freestanding ER is not affiliated with a hospital, yet it’s a 24-hour medical facility licensed to provide the same level of care as a hospital-based ER. However, most freestanding ERs do not participate in HealthSelect or other health plans. Freestanding emergency departments, on the other hand, are afflilated with hospitals, and some do participate in HealthSelect. As of Sept. 1, every freestanding ER in Texas is required by state law to post which networks it participates in on-site and online, as well as provide all patients with written confirmation of their network status.
  • Use the HealthSelect provider finder to locate the nearest in-network urgent care for problems that aren’t life-threatening but need attention before you can see your doctor (e.g., ear infections, ankle sprains, etc.). When you are treated at an urgent care, you’ll pay a $50 co-pay plus 20 percent coinsurance at in-network clinics and 40 percent coinsurance at out-of-network clinics.
  • Investigate the virtual visit services available to HealthSelect participants. As of Sept. 1, HealthSelect of Texas and HealthSelect Out-of-State participants pay $0 out of pocket for in-network virtual visits (online or by phone). This could be useful when you have a sore throat, cough, rash, etc.

Again, plan ahead so you don’t incur unnecessary out-of-pocket costs, making a bad situation even worse.