Frequently Asked Questions
Please contact your nearest location for more information.General Questions
What is an emergency room vs. an urgent care?
An emergency room treats illnesses and injuries in need of immediate attention, some of which include chest pain, abdominal pain, dehydration, complex fractures and much more.
An urgent care typically treats acute and chronic illnesses and injuries that are non-life-threatening; some of which include common colds, flu, strep throat, lacerations and more.
Will I ever be considered an ER patient without knowing?
No. Legacy ER & Urgent Care is a fully licensed emergency room that offers a unique approach to billing. During urgent care hours (7 a.m. to 9 p.m.), we may provide the benefit of courtesy urgent care billing if a medical provider feels urgent care services are appropriate. The final billing classification (emergency room vs. urgent care) is determined based on the resources utilized in your care. This ensures patients receive the appropriate level of care while potentially benefiting from reduced costs when urgent care services are sufficient. You will be informed of your billing class before you are discharged from the facility.
What is in-network vs. out-of-network?
For urgent care services at Legacy ER & Urgent Care, in-network means we have a contract with your insurance company and have agreed on what the cost is for any service provided to you. Out-of-network means we do not have a contract with your insurance company in setting the rates. As a result, you may be billed a different rate as determined by your insurance company and benefit plan.
For emergency care at Legacy ER & Urgent Care, state law says (states or requires) that all patients have to be treated regardless of their insurance plan or ability to pay. This means your insurance company should consider you in-network. We will bill you the amount defined by your insurance plan.
How does Legacy ER & Urgent Care determine what to charge patients?
Your insurance company negotiates rates on your behalf with providers such as Legacy ER & Urgent Care, and agrees upon the rates they feel are reflective of the value provided to their members. Factors involved include quality of providers, accessibility and patient experience.
What is the difference between my Explanation of Benefits (EOB) and my invoice from Legacy ER & Urgent Care?
An Explanation of Benefits, or EOB, is something the insurance company sends to the patient to explain what is allowed by their policies and what the associated charges are. 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 ER & Urgent Care.
Visit our insurance and billing page for additional information.
What is a New Patient designation?
All health care 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 those that have been seen at the office or urgent care in the past three years. The charge for an established patient visit is typically less than the new patient charge.