Billing &
Insurance
Thank you for choosing Milwaukee ER & Hospital for your emergency medical care. To better serve you, we want to make the billing process simple and transparent. We understand that some patients may find the billing process confusing or overwhelming. We want to help you understand your bill. Your bill may be different from other medical bills you may have received from hospitals or physicians. It’s important to note that Milwaukee ER & Hospital is a fully licensed hospital with ER services.
In an effort to protect patients, the federal government issued the Federal No Surprises Act (NSA). The NSA addresses several different points. The most notable point is the NSA serves to prohibit surprise billing. A surprise medical bill is an unexpected bill, often for services received from a healthcare provider or facility, that a patient may not have known was out-of-network with their insurance until a bill is received. Simply stated, an out-of-network provider cannot send a bill to a patient for any amount outside of their yearly in-network deductible and co-insurance. This does not apply to amounts paid directly to patients by their insurance provider for services rendered rather than paid to the provider. In those cases, a patient may receive a bill for full charges until the insurance payment amount is provided or paid over to the appropriate facility by the patient.
The Federal No Surprises Act was issued after lawmakers passed a law to base emergency services payments on local median in-network rates, also known as QPAs, instead of usual and customary rates. The law enacted a system where insurers and providers negotiate the correct amount to be paid. Once in agreement, the bill can be settled through an independent dispute resolution process. Insurers must now disclose how they come to the QPA-median in-network price and if they down-coded the claim for any reason.
Visit CMS.gov/nosurprises, or call the Help Desk at 1-800-985-3059 for more information.
Contact the Patient Advocacy Department at (713) 357-2535, Monday – Friday from 7:30 – 4:30 CST.
Milwaukee ER & Hospital accepts most private insurance plans such as Aetna, Humana, United Health, Cigna, and BlueCross/BlueShield. We also accept out-of-pocket payment in the form of cash, checks, or credit cards.
Your ER co-pay will be collected at the time of your visit. We will then bill your insurance company for the policy’s emergency room benefits. There will be two different claims mailed to your insurance company: the facility
bill and the physician bill. If you have any questions concerning your bill, please contact our Billing Department, Tyvan Billing at 713-357-2535.
If you have health insurance, you will receive an EOB (explanation of benefits) from your insurance company in the mail. Taking the time to be familiar with your benefits will help you make the best decisions when seeking medical care. It is important to note that the EOB is not a bill.
Milwaukee ER & Hospital is classified as out-of-network with many insurance companies; however, Milwaukee ER & Hospital does honor all in-network deductibles and benefits
Workers’ compensation is a state-funded insurance program that gives covered employees income and medical benefits if they’re injured while working. Wisconsin employers may choose to provide their employees with this coverage. Most employers will inform you as to whether or not you’re covered under this state plan.
Workers’ compensation pays medical bills and is covered underneath the Wisconsin Workers’ Compensation Act.
For all cases deemed emergent, Milwaukee state law requires your insurance company to pay for your emergency care, even if the emergency room is classified as out-of-network. The state of Milwaukee empowers patients to use a standard called the prudent layperson standard when determining what constitutes as an emergency.
If your insurance provider is refusing to reimburse you for your emergency room visit, you can file a complaint with the Milwaukee Department
of Insurance at: