No le llegarán facturas médicas sorpresa

Sus derechos y protecciones contra facturas médicas sorpresa

Cuando recibe atención de emergencia o lo atiende un proveedor fuera de la red de su plan de seguro médico en un hospital o centro de cirugía ambulatoria que sí está dentro de la red, usted tiene protección contra facturación del saldo. En estos casos, no se le debe cobrar más del copago, coseguro o deducible de su plan de seguro médico.

Balance Billing - Spanish

  • ¿Qué es la facturación del saldo (a veces llamada "factura sorpresa")?

    Cuando consulta con un médico u otro proveedor de atención médica, es posible que tenga que pagar ciertos gastos de su bolsillo, como un copago, coseguro o deducible. Es posible que haya costos adicionales o que tenga que pagar la factura entera si lo atiende un proveedor o va a un centro de atención que no participa en la red de su seguro médico. 

    “Fuera de la red" se refiere a los proveedores y centros que no han firmado un contrato con su plan de seguro para brindar servicios. Es posible que los proveedores que están fuera de la red puedan cobrarle la diferencia entre lo que paga su plan y la cantidad que se cobró por el servicio. Esto se llama "facturación del saldo". Esta cantidad probablemente es más de lo que cobran los proveedores que están dentro de la red por el mismo servicio y tal vez no cuente como parte del deducible o el límite anual que debe pagar de su bolsillo según su plan. 

    Una "factura sorpresa" es una cuenta inesperada para el pago de un saldo. Puede pasar cuando usted no puede controlar quien participa en su cuidado, como cuando tiene una emergencia o programa una consulta en un centro que está dentro de la red, pero lo atiende un proveedor que está fuera de la red. Las facturas médicas sorpresa pueden costar miles de dólares, dependiendo del procedimiento o el servicio.

  • En UTMB Health, usted tiene protección contra facturas sorpresa por:

    SERVICIOS DE EMERGENCIA

    Si tiene un problema médico de emergencia y recibe servicios de emergencia de un proveedor o en un centro que no es parte de la red de su seguro, lo máximo que le cobraremos es la cantidad que le corresponde pagar por servicios dentro de la red de su plan de salud (como copagos, coseguro y deducibles). No se le facturará el saldo faltante por estos servicios de emergencia. Esto incluye los servicios que le brindemos después de que esté en una condición estable, a menos que nos dé su consentimiento por escrito y renuncie a las protecciones contra las facturas sorpresa por estos servicios.

    CIERTOS SERVICIOS EN UN HOSPITAL O CENTRO DE CIRUGÍA AMBULATORIA QUE ESTÁ DENTRO DE LA RED

    Cuando recibe servicios de un hospital o centro de cirugía ambulatoria dentro de la red, es posible que algunos proveedores que trabajan ahí no formen parte de la red de su seguro médico. Si esto sucede, lo máximo que le cobrarán los proveedores que no forman parte de la red es lo que le corresponde a usted según su plan de seguro para proveedores dentro de la red. Esto es válido para los servicios de emergencia, anestesia, patología, radiología, laboratorio, neonatología, cirujano asistente, hospitalista o intensivista. Estos proveedores no pueden enviarle una factura sorpresa ni pedirle que renuncie a las protecciones contra estas facturas.

    Si recibe otro tipo de servicio en un centro que está dentro de la red, los proveedores que están fuera de la red no pueden enviarle facturas sorpresa a menos que usted haya dado su consentimiento por escrito y haya renunciado a las protecciones.

    Nunca le exigiremos que renuncie a las protecciones contra facturas sorpresa. Tampoco se le exige aceptar atención fuera de la red de su plan de seguro. Usted puede elegir un proveedor o centro que está dentro de la red de su plan de seguro. 

  • Cuando no se permite la facturación del saldo, también tiene estas protecciones:

    Solo es responsable de pagar lo que le corresponde del costo (como los copagos, coseguro y deducibles que pagaría si el proveedor o centro estuviera dentro de la red). Su plan de seguro médico pagará directamente a los proveedores o centros que están fuera de la red cualquier costo adicional.

    En general, su plan de salud tiene que: 

    • Cubrir servicios de emergencia sin exigirle que obtenga autorización por adelantado (también conocido como "autorización previa”),
    • Cubrir servicios de emergencia de proveedores que están fuera de la red,
    • Calcular lo que usted le debe al proveedor o centro de acuerdo con lo que le pagaría a un proveedor o centro que está dentro de la red y mostrar la cantidad en la explicación de beneficios y
    • Aplicar cualquier cantidad que usted paga por servicios de emergencia o servicios fuera de la red al deducible o límite que debe pagar de su bolsillo.

¿Necesita un presupuesto?

Tiene derecho de recibir un presupuesto de buena fe en el que se le explique cuánto costarán los servicios que va a recibir. Para más información, favor de enviar un correo electrónico a patientestimates@utmb.edu o solicitar un presupuesto para servicios clínicos.

¿Necesita ayuda?

Si cree que recibió una factura erróneamente:

Comuníquese con Servicio al Cliente de UTMB Health al 877-463-0103 o 409- 515-7049 o envíe un correo electrónico a rcobilling.customerservice@utmb.edu

Si tiene un plan de seguro médico regulado por el estado de Texas o tiene cobertura por medio de Texas Employee Retirement System o Texas Teacher Retirement System, entonces es posible que tenga protecciones adicionales contra las facturas médicas sorpresa. Para más información, visite https://www.tdi.texas.gov/medical-billing/index.html.

Para información o ayuda del Departamento de Seguros de Texas con las facturas sorpresa, visite https://www.tdi.texas.gov/medical-billing/surprise-balance-billing.html.

Visite www.cms.gov/nosurprises/consumers para más información sobre sus derechos bajo la ley federal. El número de teléfono federal para recibir información y presentar quejas es: 800-985-3059.

Insurance and Billing

  • Billing Inquiries – Single point of customer service.

    UTMB Health is also pleased to offer a single point of customer service to our patients for services provided at our facilities by UTMB providers, so that we may answer many of your billing questions with one phone number, instead of requiring separate phone calls to different billing offices for hospital/clinic fees and health care provider charges.

     You may contact our UTMB Health Customer Service Office at (877) 463-0103 or (409) 515-7049, or click to send email*

    In addition, when you check in at any of our clinics, our Patient Services Specialists will be able to discuss outstanding balances and conveniently assist you by collecting payments toward any balance due, helping you stay current with your health care financial responsibilities.

    * Please see information below regarding questions about fees from non-UTMB care providers.

  • Care Management

    UTMB is an academic teaching facility, and as such, you may see a variety of care providers during your stay with us. Care managers are assigned to medical teams to address needs during your hospital stay. These needs may include ensuring that high-quality care is delivered in an efficient manner, proactively planning for your discharge early during your hospital stay, and identifying solutions to discharge barriers that could otherwise delay your return home.

    Care managers are available Monday–Friday, 8 a.m.–5 p.m. If you anticipate problems returning home after discharge, please contact (409) 772-1541 so your care manager can speak with you about your concerns.

  • Charity Care and Financial Assistance Policy

    Current UTMB patients are eligible to apply for financial assistance related to services already provided at UTMB. Existing UTMB and non-UTMB patients may contact Financial Counseling at (409) 772-6464 to learn about the application process.

    Patients are not eligible for financial assistance if they a) have third party insurance (excluding patients with traditional Medicare); or b) if they are eligible for another third party program such as Medicaid, County Indigent Health Programs (CIHCP), etc; or c) are not Texas residents. Patients seeking treatment for certain elective, non-emergent procedures or outpatient services will be considered full pay patients, and payment in full will be expected at or before the time services are rendered.

    Qualified applicants whose income and calculated assets are below 200% of the levels indicated in the Federal Poverty Guidelines (found at http://aspe.hhs.gov/poverty/) will qualify for a 100% charity discount on any balances.  Qualified applicants whose income and calculated assets are equal to or greater than 200%−but below 400% of the Federal Poverty Guidelines − will qualify for a 75% charity discount on any balances.

    The Financial Counseling Office manages the process of vetting requests for assistance. An interview/screening process conducted by the office will determine if an individual is eligible to receive discounted medical services at UTMB.

    Self-pay patients (individuals who are personally responsible for their bills because they do not have third party coverage, and do not qualify for full or partial charity care discounts) with income levels equal to or greater than 400% of Federal Poverty Guidelines may qualify for discounts up to 40% for inpatient services and 50% for outpatient services received.

  • Hospital Costs and Charges

    If you are considering a hospital procedure and are interested in an estimate of the cost, or are comparing costs among different providers, the following page offers helpful information for you, including a definition of the hospital "chargemaster." Costs and charges information.

  • Insurance Claims and Payment Policies

    All accounts are payable in full upon receipt of your statement. If you have commercial health insurance, your coverage will be verified and a claim will be filed on your behalf. Our billing departments will cooperate fully with you and your insurance company to expedite payment of your claim.  If you have assigned insurance benefits to UTMB, your insurance company has 60 days from the date the claim is filed to complete payment.

    In the event your insurance company fails to pay the claim after 60 days, it may be necessary for UTMB  to ask you to pay your hospital or physicians’ bills.

    Please remember that the patient or guarantor, not the insurance company, is responsible for the settlement of the account. Once your insurance payment has been received, any remaining balance is expected in full, within 30 days.

    If you cannot pay your patient balance in full, it may be possible to establish a payment plan. The term and payment amount is determined according to the amount owed. A customer service account specialist can assist you in establishing a payment plan. For more information, please call: 

    For payment plan information, please contact our Customer Service Office at (877) 463-0103 or (409) 515-7049 or email RCObilling.customerservice@utmb.edu

  • Insurance Network Participation Notification
    It is policy at UTMB Health for our registration staff to provide a written disclosure to all patients receiving care as to whether the services requested/received are considered in-network or out-of-network. The guidance UTMB provides is based on the information provided by the patient at the time of service, and availability of the insurance company or other provider to confirm coverage details. Disclosures are provided in the Emergency Room, inpatient areas, day surgery units, ancillary areas, and clinics.
  • Insurance Plans Accepted

    At UTMB Health, we serve patients with many types of insurance coverage, offered by many different companies and entities. UTMB and its providers accept most major health plans, which are outlined online. Remember to always check with your health insurance carrier regarding specific covered services. The list grows and changes frequently. If you don't see your insurance listed or if you have any questions, please contact us.

  • Interest Applied to Billed Services
    At this time, per its current policy, UTMB Health does not apply interest charges to bills issued for its clinical services.
  • Patient Complaints

    At UTMB Health, our goal is to care for you in a manner that consistently meets and exceeds your expectations. If we fall short of that goal, our Patient Services department is in place to provide a centralized and effective mechanism to investigate, address and hopefully resolve a given issue.

    You may contact the department by mail, phone or email:

    UTMB Health Department of Patient Services
    Route 0306
    Galveston, Texas 77555-0306
    (409) 772-4772
    patient.services@utmb.edu

  • Payment options for Patients without MyChart Access

    If you would like to make a payment on your account (for services rendered after April 6, 2013) but are not a MyChart user, please call:

    UTMB Customer Service: (877) 463-0103 or (409) 515-7049.
    We accept the following forms of payment: formsofpayment

  • Policies regarding UTMB Health’s Discounting, Pricing and Billing Procedures

    In accordance with Senate Bill 1731 (“Healthcare Transparency”) and in addition to the information offered above, UTMB posts for its patients policies on billing and collection practices. If you don’t have access to the internet or would prefer a written copy, please call (877) 463-0103 or (409) 515-7049.

    Available documentation on policies and procedures include:

    • Discounting charges for uninsured patients [See policy]
  • Requesting an Estimate

    UTMB Health is happy to provide estimates for its services, and typically  provides a response to requests in 2-3 business days. Get details and make a request.


    myChart Patient Estimate Tool

    The myChart Patient Estimate is an online tool to assist patients with an estimate based on their insurance and benefit plan. This enables the patient to create an estimate without having to call RCO and satisfies the requirement for displaying 300 shoppable services for the price transparency rule.

    Click to use the myChart Patient Estimate Tool
  • Requesting an Itemized Statement

    UTMB will mail you a monthly statement on each account on which you owe a balance. If you would like to receive a more detailed list of your hospital or professional charges, you may request an itemized statement. Our customer service account specialists can assist you via telephone, or you may submit a request for an itemized statement via email. Statements will be sent via US Mail to you at your address of record.

    For itemized bills and information, please call (877) 463-0103 or (409) 515-7049 or email RCObilling.customerservice@utmb.edu

ALERT BAR

 Contacts & Resources