Know your options—and the costs—for urgent and emergency care

If you are enrolled in a HealthSelect plan (except for HealthSelect Medicare Advantage), you will pay more if you get medical care at a freestanding emergency room (ER) that is not in the HealthSelect network.  

After January 1, 2020, if you get care at any out-of-network facility or provider for a true emergency on or after January 1, 2020, you cannot be balance billed. In other words, you are not responsible for any difference between the amount billed by the facility or provider and the out-of-network allowable amount. However, you may pay a higher copay and will pay a higher share of coinsurance. 

If it’s not a true emergency, it’s best to avoid ERs or you can expect to pay much more – sometimes thousands of dollars more. Instead, choose one of the in-network options available, such as a medical virtual visit or a visit to your primary care provider’s (PCP’s) office, urgent care facility or retail health clinic. 

HealthSelect of Texas® and HealthSelect Out-of-State
Out-of-Pocket Costs for Freestanding Emergency Facilities*

How does my cost differ if I get emergency care at the hospital emergency room? See the following chart.
Freestanding Emergency Room
(freestanding ER not affiliated with a hospital)
In-NetworkOut-of-Network
You may be balance billed by provider.
 
True Emergency$150 copay
+
20% coinsurance
$300 copay
+
20% coinsurance

Annual out-of-network deductible does not apply.
You cannot be balance billed. 
Non-Emergency$150 copay
+
20% coinsurance
$300 copay
+
40% coinsurance

After meeting the annual out-of-network deductible ($500/individual, $1,500/family)
You can be balance billed.
Freestanding Emergency Department
(hospital-affiliated freestanding emergency facility)
In-NetworkOut-of-Network
True Emergency$150 copay
+
20% coinsurance
$150 copay
+
20% coinsurance

Annual out-of-network deductible does not apply.
You cannot be balance billed.
Non-Emergency$150 copay
+
20% coinsurance
$150 copay
+
40% coinsurance

After meeting the annual out-of-network deductible ($500/individual, $1,500/family)
You can be balance billed./em>

Where should I go for different kinds of care?

Hospital emergency rooms are for life-threatening or very serious conditions that need immediate care.

There are no-cost or lower-cost options if you do not have a life-threatening or critical condition.

  • Medical virtual visits - See a doctor 24/7 via your smartphone, tablet or computer for non-emergency medical conditions. HealthSelectSM of Texas, HealthSelectSM Out-of-State, and HealthSelectSM Secondary participants pay no copay for this visit when they use Doctor on Demand or MDLive. (Consumer Directed HealthSelect participants must meet their annual deductible, and then pay 20% coinsurance after the deductible is met.)
  • PCP’s office - Your PCP knows you and your health history and can provide routine and preventive care and treatment for a current health issue. If needed, they can refer you to a specialist. HealthSelect of Texas and HealthSelect Out-of-State participants pay a $25 copay for in-network PCP visits. Consumer Directed HealthSelect participants pay the full cost until they meet their annual deductible, then pay 20% coinsurance after the deductible is met.
  • Retail health clinic - Retail health clinics are often located in stores and pharmacies to provide convenient, low-cost treatment for minor medical problems. In-network retail health clinics usually have a lower out-of-pocket cost than urgent care.
  • Urgent care center - Urgent care centers offer treatment for non-life-threatening injuries or illnesses, including sprains, minor infections and minor burns. HealthSelect of Texas and HealthSelect Out-of-State participants pay a $50 copay plus 20% of the contracted allowable amount for in-network urgent care centers. Consumer Directed HealthSelect participants pay the full cost until they meet their annual deductible, then pay 20% coinsurance after the deductible is met.
  • Emergency room - This is typically the highest-cost option. If you need immediate treatment of a life-threatening or critical condition, go to the nearest emergency room. Do not ignore an emergency. Call 911 if the situation is life threatening. If you go to a hospital-based ER, HealthSelect of Texas and HealthSelect Out-of-State participants pay a $150 copay plus 20% coinsurance. (Copay applies to the hospital copay, if you’re admitted.) Consumer Directed HealthSelect participants pay the full cost until they meet their annual deductible. Once they’ve met the deductible, they pay 20% coinsurance for the emergency care and, if they’re admitted, 20% coinsurance for any hospital costs.

Learn more about Options for Care.