Understanding Your In-Network Benefits at Family Hospital

We Are in Network with Most Major Payors, Including Medicare

At Family Hospital at Lake Travis, we understand that navigating medical expenses and insurance plans can be overwhelming. Our dedicated patient advocacy team is here to guide you through the complexities of healthcare billing, ensuring you feel comfortable asking questions about your recent visit, insurance copayments, deductibles, and any outstanding balances. We're committed to providing clarity and support throughout your billing process. If you have concerns about your medical bills or insurance coverage, don't hesitate to reach out to our team at Family Hospital at Lake Travis.

Using Your In-Network Benefits

Understanding when to utilize your in-network benefits is crucial for managing healthcare costs. Family Hospital at Lake Travis is here to help you navigate this process effectively.

The Billing Process

• Understanding the lifecycle of a healthcare bill.

In-Network vs. Out-of-Network - State and Federal Laws

• You will only be responsible for your In-Network cost-sharing amount. State and Federal laws require insurance companies to pay for emergency care regardless of the in-network or out-of-network status of the facility. During your registration, you will be asked to sign an authorization form which allows us to Negotiate and Appeal your claim with your insurance company for reimbursement on your behalf. You will never get "stuck in the middle" at our facility.

The Claim

• We send your medical claim to your insurance company. Once your insurance company receives the claim, they are supposed to respond within 15 days. They have 35 days to offer payment to settle.

Explanation of Benefits (EOB)

• Approximately two weeks after your visit, you may receive an Explanation of Benefits (EOB) Statement from your insurance company. Do not worry! This is not your bill, and please disregard the section of the EOB statement that states “You may owe $.”
• The amount stated on the EOB is not a bill from us.

How We Deal With Undervalued Claims

• If your insurance company has undervalued your claim, Family Hospital at Lake Travis will send an appeal to the insurance company asking them to reimburse at fair market value. The insurance company then has up to 120 days to send additional reimbursement or a formal denial of additional payment. The insurance industry often will require 3 separate levels of appeals each taking up to 120 days. It is common for the appeals process to take up to a year. If the appeals process fails to encourage your insurance to properly value the claim, after we’ve exhausted the appeals process, Family Hospital at Lake Travis will send you a bill. This will only be for your In-Network responsibility and never a balance bill.

What Does the Bill Sent to You Mean?

• Once we have completed the appeals process, if necessary, Family Hospital at Lake Travis will send you a bill for the amount requested by your insurance company for the claim. This is not a balance bill. It is your coinsurance or deductible amount for your in-network benefit. If you have questions or difficulties, please call us. We are here to help in every way.

Still have a question? Please contact us.