FREQUENTLY ASKED QUESTIONS

An urgent care typically treats non-life threatening conditions, some of which include common colds, flu, strep throat, lacerations and more.

An emergency room treats conditions in need of immediate attention, some of which include chest pain, abdominal pain, dehydration, complex fractures, and much more

Selection of the right facility can make a big difference in the financial outcome of your visit. Choosing an emergency room and not having an emergency means you will substantially overpay for your treatment. Selecting an urgent care and needing an emergency room will add additional unnecessary cost, but more importantly possibly waste valuable time being transferred to a facility that is capable of treating your condition.

Legacy ER & Urgent Care was founded on the premise of solving this problem. Each facility is equipped to handle the seriousness of any emergency while being able to bill what turns out to be lower acuity needs at urgent care billing rates. This means that as a patient you do not have to try to self-triage on where to go. The answer is to always choose Legacy ER & Urgent Care and know your bill will be reflective of only the care you require to treat your condition. Why is this significant? Because 44%-65% of national ER visits could have been treated and billed at urgent care rates, but weren’t. With over 80% of our patients receiving urgent care billing, we are vastly improving cases of unnecessary ER visits while saving our communities millions in health care costs.

The short answer is absolutely not, and we mean this emphatically. We require that an additional consent be obtained to make sure there are no surprises, which goes far beyond what is required.

Legacy offers the largest amount of operating hours in which urgent care level billing is available in all of North Texas. Our research has shown that they vast majority of lower acuity patients that would qualify for urgent care billing seek care between the hours of 7:00am-9:00pm, thus our hours of urgent care billing were set. This allows for accurate staffing to ensure our patients are always able to receive high quality patient care at an unmatched level of efficiency.

Urgent Care Billing 7A-9P Everyday (the most urgent care hours in DFW) ER Open 24/7/365

Unfortunately, Medicare only recognizes and reimburses emergency services at locations licensed as a department of a hospital. Since Legacy operates independently, and not as a department of a hospital, Medicare does not recognize our facilities as being eligible to provide emergency services. Medicare does not require licensure as a hospital department in order to reimburse for urgent care services, so we are happy to provide those services to all patients covered by Medicare.

We will never turn you away if you have an emergency. We will provide a medical screening evaluation (MSE) of your condition, and if you choose to continue care with Legacy, your costs will most likely be higher than at a Medicare participating facility.

All healthcare insurance, including Medicare, set a distinction for first visits in an office or Urgent Care setting. The new patient charge is typically reimbursed at slightly higher rates than all following visits to the same location, due to the additional work required to set up new accounts and obtaining all the necessary details to make this happen. Established patients are ones that have been seen at the office or Urgent Care in the past three years and the charge for this visit is typically less than the new patient charge.

Your insurance company negotiates rates on your behalf with providers such as Legacy ER & Urgent Care, and agrees upon rates in which they feel are reflective of the value provided to their members. Factors that determine what rates your insurance carrier agrees to include quality of providers, accessibility, & patient experience.

An EOB is something the insurance company sends that explains what is allowed by their policies and what the associated charges are for what these allowances. It is not a bill, but rather a communication from the insurance company to the patient. It may or may not correspond directly to what the final bill is from Legacy. Best thing to do is to not let the EOB confuse you and wait until LER bills you. Then, if you have any questions or concerns, we can help sort those out for you.

In-network means we have a contract with your insurance company and have agreed on what the rates for any service provided to you will be. Out of network means that we do not have a contract with your insurance company in setting the rates, but as a company policy we have agreed to only bill you what the in-network allowed rates are. In the emergency room, state law dictates that all patients have to be treated as if they are in-network, regardless of the in or out of network status deemed by your insurance company.

See above, but basically if you have any questions or problems with your invoice, we are happy to help you in making sure that it is correct. Sometimes this requires us to file appeals or have you call your insurance company, however these are things we will walk you through while assisting you every step of the way.

If you have any questions about your bill, your Explanation of Benefits, or health coverage call 1-888-862-7788 or fill out our contact us form.