Page 11 - 2020 Summer Enrollment

Maria spent Saturday doing yardwork, and now she’s paying for it with pain in her lower back. She can’t sleep and really needs some relief. Does she need to go the ER? Can she wait until Monday to see her PCP?
The good news is, Maria doesn’t have to make this decision alone.
She calls the 24/7 Nurseline at (800) 581-0368. The nurse answers her questions and offers suggestions for temporary relief.
The nurse also explains Maria’s options for care and recommends she visit an urgent care clinic on Sunday. Maria won’t have to wait until Monday, and she can avoid the high ER bills.
Freestanding Emergency Rooms — $$$$$$
For life-threatening symptoms as a last resort if no in-network hospital ER is available as bills can be higher.
For an out-of-network freestanding emergency room, you will pay more.
∙ You must pay a $300 copay. (Note: There is no copay for those enrolled in Consumer Directed HealthSelect but you must meet your deductible before benefits are paid).
∙ There is not a deductible if true emergency but out-of-network deductible applies if not a true emergency.
∙ The plan pays 80% of the out-of-network allowable amount if true emergency and 60% of the out-of-network allowable amount if not a true emergency.
∙ You may be responsible for any difference between the amount billed by the facility and the out-of-network allowable amount, which could be significant.
A freestanding emergency room (FSER) is a medical care facility that provides emergency services, and typically is not affiliated with a hospital or physically connected to a hospital. FSERs are frequently located near a shopping center or other convenient neighborhood location. While a FSER may seem like a convenient option when you need emergency care, most are out-of-network and you will pay more—sometimes thousands of dollars more—for care and you still may need to be sent to a hospital for emergency care.
Call a BCBSTX Personal Health Assistant toll-free at (800) 252-8039, Monday - Friday 7 a.m. - 7 p.m. and Saturday 7 a.m. - 3 p.m. CT 11