Billing Questions & Answers
How can I get help finding the right health insurance plan for me and my family through the Marketplace? Enrollment for the Affordable Care Act (ACA) is currently open. If you are currently without health insurance or need additional coverage, now is the time to protect your health and your family by enrolling in a Marketplace insurance plan at healthcare.gov. Certified Application Counselors are available by appointment at United Regional to help you find a plan that’s right for you and your family. On-site and virtual appointments are available starting April 6, 2021. To schedule an appointment, please click here.
How do I know if United Regional contracts with my health plan? To receive full insurance benefits, some insurance providers require patients to receive services with “in-network” or “participating provider” hospitals and physicians. Call your insurance provider to check its requirements and to make sure United Regional is in the network.
What Medicare Advantage plans are United Regional and United Regional Physician Group currently contracted with?
United Regional and URPG accepts traditional Medicare and currently contracted with the following Medicare Advantage plans: Aetna, Humana, UnitedHealthcare and American Health Plans. For questions, call 940-764-8242.
If United Regional is “out of network,” may I still go there?
In an emergency, always go to the closest hospital. Your insurance provider generally will cover emergency department costs or transfer you to an “in-network” hospital if it is safe to do so. If you choose to go to an “out-of-network” hospital in a non-emergency, you may be required to pay a larger deductible or a greater portion of your bill. Be sure you understand your health plan’s “out-of-network” options. Non-contracted Medicare Advantage plans are not accepted at United Regional effective 1/1/2021, except in emergencies. For a complete listing, please contact 1-800-MEDICARE (1-800-633-4227; TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult Medicare.gov. Current contracted in-network Medicare Advantage plans are available with Humana. United Regional also remains in-network for Medicare Traditional. For questions about Medicare enrollment, please contact 1-800-633-4227 (1-800-Medicare). For more information about Humana Medicare Advantage plan enrollment, contact 1-800-833-2364. To speak to a United Regional insurance representative, please call 940-764-8242.
How can I be sure my insurance provider will pay my bills?
Some health plans require certain services to be authorized, or pre-certified, before the patient receives them. Other health plans require the patient to notify them within a certain period of time after services are rendered. Know your health plan’s requirements by reading the information given to you by your insurance provider or employer, or by calling your insurance provider directly. You also may call a United Regional billing representative to discuss insurance payment concerns.
Does United Regional send the necessary information and paperwork to insurance providers?
We try to send all the necessary information to insurance providers; however, they sometimes need more information from you to process a claim.
How will I know how much I owe?
Your insurance provider will send you an Explanation of Benefits (EOB) notice that details the amount it has paid, any non-covered or denied amounts, and the remaining balance that you are responsible for paying to United Regional. Review your EOB carefully, compare it to your United Regional billing statement, and call your insurance provider or a United Regional billing representative right away if you have questions or concerns. Also, many health plans require patients to pay a co-payment or deductible amount that may be due at the time of registration or discharge from the hospital.
How often will I receive a statement?
Statements are issued monthly. You will receive a statement every month until all payments are made, either by the insurance company or the patient.
What if there is a mistake on my statement?
If you have billing questions, call the United Regional’s Patient Financial Services Department at 940-764-8242 between 8 a.m. – 4:30 p.m., Monday through Friday. You may also email questions to firstname.lastname@example.org.
Why does the statement show a total account balance when I have insurance coverage?
Most likely, United Regional hasn’t yet been paid by your insurance company. In most cases, your insurance company will make payment as long as the services are covered under your benefit plan. However, if your insurance plan does not cover the services you received, you are financially responsible for them.
What does “adjustment” mean?
“Adjustment” refers to the portion of your bill that the hospital expects to reduce the bill due to the insurance provider contract. This amount is applied at the time of billing but could change when insurance benefits have been finalized due to deductibles or other items deducted by your payer.
Does United Regional bill secondary insurances?
Yes, United Regional is dedicated to helping you receive full benefits from your insurance provider. You will be asked to provide complete insurance information upon registration. Be sure you have a copy of your insurance cards at that time. As a service to you, we will submit secondary claims along with required Explanation of Benefits from your primary payer to your insurance provider. However, if your insurance provider doesn’t make payment within 60 days or respond to our requests for final determination, we will ask you to pay the amount owed.
What if I don’t have health insurance?
Be assured that emergency service will never be delayed or withheld on the basis of a patient’s ability to pay. If you do not have health insurance, call the Patient Financial Services Department at 940-764-6124. The billing representative will review payment and financial assistance options that may be available to you.
What if I cannot pay the amount I owe in full?
Call the United Regional’s Patient Financial Services Department at 940-764-8242 and inquire about applying for financial assistance or being set up on a payment plan. We will be happy to work with you to set up a mutually agreeable payment plan and to answer your questions. Partial payments made toward your balance will stop collection activity only if you have made payment arrangements with us. Please call us to make arrangements.
May I pay my bill with a credit card?
Yes. For your convenience, United Regional accepts cash, personal checks, debit cards or money orders, Visa, MasterCard, Discover and American Express. We will charge your credit card only for the amount you authorize. Payment plans also may be arranged through the United Regional’s Patient Financial Services Department.
Why did I receive a bill for a doctor I did not see?
While you are a patient at United Regional, you may be treated by health care providers who are independent practitioners, such as emergency department physicians, radiologist reading exams, anesthesia providers, hospitalists and others. Although these are independent practitioners participate in your care at the hospital, they will bill you separately through their own billing office and not by the hospital.
Estimates & Pricing Information
United Regional provides a user-friendly option for patients to shop for a price estimates without a log in to any application. Visit MyChart and select “Get a Price Estimate,” which is located below the log-in and “Sign up now” options, to begin shopping for the most common 300 estimates. We encourage patients to contact us with any questions about estimates. Please contact our Insurance Verification team at 940-764-6140. Their office hours are Monday through Friday, 7 a.m. to 5:30 p.m.
United Regional also provides a machine-readable file (751912147_unitedregionalhealthcaresystem_standardcharge.xlsx) for services provided, as required by the Centers of Medicare & Medicaid Services. The charges in this document do not reflect patients true out-of-pocket expense. Actual costs will vary for each patient depending on services ordered, insurance coverage and other determining factors. We encourage patients to not to rely on the machine-readable file but to use the “Get a Price Estimate” option above, or call our team for more information.
Some phone numbers you may need:
- 24 On Physicians (888) 646-7763 (InCompass)
- Acute Care Surgery of Texoma (512) 343-8070
- Air Evac (866) 686-0662
- AMR (American Medical Response) (800) 711-2703
- Care Flight (972) 339-4200
- La Magna (940) 764-3979
- OB Hospitalist Group (888) 442-8454
- Observation Services of Wichita Falls (940) 228-3166
- Pathology Associates (940) 322-7284
- Radiology Associates (844) 838-4049
- Titanium Emergency Room Physician Group (940) 228-3166
- Transtar (940) 696-6400
- United Regional Physician Group (940) 764-8263
- United Regional Reference Lab (940) 764-5150
- WF Anesthesia (855) 338-1409
Your Rights and Protections Against Surprise Medical Bills
When you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing.
What is “balance billing” (sometimes called “surprise billing”)?
When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, such as a copayment, coinsurance, and/or a deductible. You may have other costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network.
“Out-of-network” describes providers and facilities that haven’t signed a contract with your health plan. Out-of-network providers may be permitted to bill you for the difference between what your plan agreed to pay and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your annual out-of-pocket limit.
“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care—like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider.
You are protected from balance billing for:
- Emergency services: If you have an emergency medical condition and get emergency services from an out-of-network provider or facility, the most the provider or facility may bill you is your plan’s in-network cost-sharing amount (such as copayments and coinsurance). You can’t be balance billed for these emergency services. This includes services you may get after you’re in stable condition, unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services.
Texas law protects ptients with state-regulated health insurance (about 16 percent of Texans) from surprise medical bills in emergencies or when they didn’t have a choice of doctors. The law bans doctors and providers from sending surprise medical bills to patients in those cases.
- Certain services at an in-network hospital or ambulatory surgical center: When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers may bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers can’t balance bill you and may not ask you to give up your protections not to be balance billed.
If you get other services at these in-network facilities, out-of-network providers can’t balance bill you, unless you give written consent and give up your protections.
Texas law also prohibits balance billing for any health care, medical service or supply provided at an in-network facility by an out-of-network physician or other provider and for services by diagnostic imaging providers and laboratory service providers provided in connection with a health care service performed by a network physician or provider.
You’re never required to give up your protections from balance billing. You also aren’t required to get care out-of-network. You can choose a provider or facility in your plan’s network.
When balance billing isn’t allowed, you also have the following protections:
- You are only responsible for paying your share of the cost (like the copayments, coinsurance, and deductibles that you would pay if the provider or facility was in-network). Your health plan will pay out-of-network providers and facilities directly.
- Your health plan generally must:
- Cover emergency services without requiring you to get approval for services in advance (prior authorization).
- Cover emergency services by out-of-network providers.
- Base what you owe the provider or facility (cost-sharing) on what it would pay an in-network provider or facility and show that amount in your explanation of benefits.
- Count any amount you pay for emergency services or out-of-network services toward your deductible and out-of-pocket limit.
If you believe you’ve been wrongly billed, you may contact the Centers for Medicare and Medicaid Services at (800) 633-4227 or the Texas Department of Insurance at (800) 252-3439.
Visit https://www.cms.gov/nosurprises for more information about your rights under federal law. Visit https://www.tdi.texas.gov/medical-billing/surprise-balance-billing.html for more information about your rights under Texas law.