All health insurance plans, including Medicare, classify you as a new patient
the first time you visit to a doctor’s office or an urgent care
location. That’s because gathering all the important information
needed to set up new accounts takes a significant amount of time and effort.
To help with these costs, insurance plans provide reimbursement for a
“new patient” at slightly higher rates than all following
visits to the same location.
You’re considered an established patient if you’ve been seen
at the same office or urgent care in the past three years, with charges
for these visits reimbursed at lower rates than for new patients.
In-Network vs Out-of-Network
For urgent care services at OU Health ER & Urgent Care, in-network
means we have a contract with your insurance company agreeing on the cost
for any service provided to you. Out-of-network means we do not have a
rate-setting contract with your insurance company, so you may be billed
a different rate, as determined by your insurance carrier and your specific
benefit (insurance) plan.
For emergency care at OU Health ER & Urgent Care, state law requires
that all people must receive treatment, regardless of insurance plan or
ability to pay. This means your insurance company should consider you
in-network. OU Health ER & Urgent Care will bill for the amount defined
by your insurance plan.
Setting Rates & Charges
On your behalf, your insurance company negotiates rates with healthcare
providers, such as OU Health ER & Urgent Care, and agrees on rates
they feel reflect the value of healthcare services to their plan members.
Factors used by your insurance company to determine rates include quality
of providers, accessibility and patient experience.
Informed Consent
To ensure you clearly understand everything involved in your care and billing
throughout your visit to OU Health ER & Urgent Care, you’ll
stay informed about whether you’re considered an emergency (ER)
or urgent care patient. If your condition needs emergency care, you’ll
be asked to provide your written, informed consent (signature) to avoid
surprises and ensure you understand all tests and treatments.
Invoices & Explanation of Benefits (EOB) Statements
Your insurance company periodically sends you an Explanation of Benefits
(EOB) statement to explain the coverages and related charges allowed by
their policies. An EOB simply communicates information to you from your
insurance company – it’s not a bill. An EOB may or may not
directly match the final bill you receive from OU Health ER & Urgent Care.
To avoid confusion, you may want to wait until you receive an invoice from
OU Health ER & Urgent Care. Then, if you have questions or concerns
about differences between an EOB and your OU Health invoice, you can contact
us for help in sorting out the details.
If we need to file an appeal on your behalf or if we need to have you call
your insurance company, we will walk you through every step of the process
and help you all along the way.
