Insurance

Is CapRock “In-Network”?

All CapRock Health System facilities and providers are now in-network with Blue Cross and Blue Shield of Texas, Cigna, and Medicare.

CapRock is able to process the following BCBSTX plans:

  • PPO
  • Indemnity
  • Blue Essentials HMO
  • Blue Advantage HMO

Additionally, at CapRock, we process the majority of other commercial insurance plans at our hospital and 24-Hour Emergency Center (excluding Medicaid, Tricare, or VA insurance).

In an emergency, all hospitals are treated the same by insurance companies, regardless of network status. Learn more about Insurance & Emergency Care.

Do you accept Medicare? 

Yes. CapRock Health gladly accepts and welcomes patients insured by Medicare. The same facilities and services that are available to patients with other commercial insurance providers are also available to those who participate in Medicare. 

The Hospital and the 24-Hour Emergency Center (licensed as an outpatient department of the Hospital), are enrolled under Medicare Part A. Outpatient services are enrolled under Medicare Part B.

Do you welcome VA benefits?

VA benefits may be utilized at CapRock Health for EMERGENCY CARE ONLY.

Emergency Care, per the VA – During a medical emergency, Veterans should immediately seek care at the nearest medical facility. A medical emergency is an injury, illness or symptom so severe that without immediate treatment, you believe your life or health is in danger. If you believe your life or health is in danger, call 911 or go to the nearest emergency department right away.

Veterans do not need to check with VA before calling for an ambulance or going to an emergency department. During a medical emergency, VA encourages all Veterans to seek immediate medical attention without delay. A claim for emergency care will never be denied based solely on VA not receiving notification prior to seeking care.

It is, however, important to promptly notify VA after receiving emergency care at a community emergency department. Notification should be made within 72 hours of admission to a community medical facility. This allows VA to assist the Veteran in coordinating necessary care or transfer and helps to ensure that the administrative and clinical requirements for VA to pay for the care are met.

Can a doctor see me if I do not have insurance or money? 

Please reference our FAQ Page for the answer to this question.

Know your benefits

Health insurance benefits are complicated and widely vary according to your insurance carrier and particular insurance plan. However, there are a few essential points; all of us should be familiar with co-pays, deductibles, or coinsurance.  Your benefits and associated out-of-pocket expenses are part of a contract with your insurer. Therefore, CapRock nor any other provider can change them.

We recommend understanding your responsibilities before you need care so that you are not surprised by any out-of-pocket costs. Please refer to your policy or call your insurer for more information about your specific benefits. 

What is my “out-of-pocket” expense? 

CapRock will process your insurance (see above “Will CapRock process my insurance”); however, in addition to what your insurance pays, you may have out-of-pocket responsibilities determined by your contract (policy) with your insurer. These out-of-pocket responsibilities (including your copay, remaining deductible, and coinsurance), are predetermined and required by your insurance plan, and are not the same as balance billing (see “Does CapRock Balance Bill” below for more information).

Unfortunately, average out-of-pocket expenses required by insurers have increased significantly over the past few years. Thus, it is important for you to consider these when choosing a policy and before seeking care. These include:

  • A Copay is a fee an insurance plan requires the beneficiary to pay at the time of service. The amount varies according to the insurance carrier, your specific insurance plan, and legally may not be waived by any provider.
  • deductible is an out-of-pocket amount that a beneficiary must pay before the insurance plan begins to pay for medical expenses. These almost always renew upon the new year, meaning that even if you met your deductible last year, you must meet it again this year before your insurer begins to cover any expenses.  
  • Coinsurance is the percentage of medical expenses you owe after meeting your deductible. Note: all plans include coinsurance responsibilities.

How do you handle bill payments at CapRock? 

For patients with insurance, although your health plan determines the amounts of your co-pay, deductible, and co-insurance, all providers, including CapRock Health System, are required to collect these amounts from you.

  • CapRock is required to collect your copay at the time of your visit. Failure to do so is a breach of your agreement with your health plan as well as a breach of our contract with your insurance carrier.
  • Furthermore, if you have not met your out-of-pocket responsibilities with your insurer for the year, we may collect a portion of your unmet deductible and/or coinsurance at the time of your visit.

For patients without insurance, we offer discounted rates as an option.  These prices and other details will be discussed with you after any emergency is stabilized and before you decide to proceed with our services. 

Regarding emergency care, CapRock will evaluate and stabilize any emergency regardless of your financial status.

Insurance & Emergency Care

If you believe you have an emergency, you should visit the nearest ER without worrying about your insurance’s network status. To prevent dangerous delays during an emergency, your insurance carrier is required to cover your emergency care without regard to network status.  These laws exist so that if you are not near an “in-network” hospital during an emergency, you can go to the closest facility and be confident your care will be covered according to your health plan agreement. Please note that this only applies to emergency care received at a licensed emergency room. 

Network status does not apply to emergency care. Both Texas and federal law require that all insurance plans (other than Medicare, Medicaid, and Tricare) treat every licensed ER as in-network when paying claims. 

Regarding “in-network” status for emergency services at CapRock hospital and CapRock 24-Hour Emergency Center, we process all commercial insurance plans at in-network rates for emergency care.  We have processed hundreds of plans, all at in-network rates. It is not possible to be in-network with all plans, but CapRock can process them at in-network rates as the law requires.

Insurance & Non-Emergency Care

For non-emergency care at CapRock, such as inpatient hospital services, outpatient radiology, and outpatient laboratory testing, we offer three means of payment: in-network billing, out-of-network billing, or cash pay services.  

In-network Billing

As is customary for hospital systems, for our services that are in-network with your insurance company, we will request at the time of your visit a good faith payment towards your copay, coinsurance, or deductible based on your health plan benefits at the time of your visit.  We will bill any remaining amount to your insurance company, which will determine payment based on our contracted rate for services. Any out-of-pocket expenses reduce your in-network deductible and maximum out-of-pocket for the remainder of your policy’s term.

Out-of-network Billing

As is customary for hospital systems, for our services that are out-of-network with your insurance company, we will request a good faith payment towards your copay, coinsurance, or deductible based on your health plan benefits at the time of your visit.  We will bill any remaining amount to your insurance company, which will process the payment as out-of-network. Any out-of-pocket expenses go towards reducing your out-of-network deductible and maximum out-of-pocket for the remainder of your policy’s term.

Cash Pay Services

We offer reduced cash payment options for a range of services, primarily for outpatient radiology, and laboratory services.  

Does CapRock balance bill?

CapRock Health System does not “balance bill.”

  • “Balance billing” is the process whereby some hospitals bill a patient for the difference between the amount of the hospital charges and the amount the patient’s insurance provider approves for payment (the “allowed” amount).
  • As explained above in “Will CapRock process my insurance?”, for medical emergencies, Texas and Federal law require all insurance providers to pay in-network benefits for any member presenting to a licensed emergency room for medical treatment. With state-licensed emergency departments, CapRock 24-Hour Emergency and CapRock Hospital process all commercial insurance plans at their in-network rates for emergency care, and does not balance bill any difference between the in-network allowed amount and our charges.  
  • By not balance billing, it does not mean that CapRock patients will not have some out-of-pocket expense (see “What is my out-of-pocket expense?”).  Since most insurance plans now include and require hospitals to collect copays, deductibles, and coinsurance, the majority of visits (regardless of the facility visited or the insurance plan used) will result in the patient having some out-of-pocket expense. When this occurs, our billing company will send a bill to the patient or responsible party.
  • Note: Your insurer sets Out-of-pocket amounts, not CapRock Health System, and CapRock cannot change them or wave them.

Why am I receiving a bill when I already paid my co-pay? 

Please reference “How do you handle bill payments at CapRock?” above.