Insurance

Will CapRock process my insurance? 

At CapRock Health System, we process the majority of commercial insurance plans at our hospital, 24-Hour Emergency Center, and urgent cares (excluding Medicaid, Medicare, Tricare, or VA insurance).

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 there are a few essential points; all of us should be familiar with co-pays, deductibles, or coinsurance.  These details vary widely according to your insurance carrier and particular insurance plan, and CapRock nor any other provider can change them.

We recommend understanding your responsibilities 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, you may also have an out-of-pocket responsibility in addition to what your insurance pays. Your insurance policy determines your copay, remaining deductible, and coinsurance, and this constitutes the total out-of-pocket amount required by your insurance plan, which is not the same as balance billing (see “Does CapRock Balance Bill” below for more information).

  • 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. 
  • 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. 

How do you handle bill payments at CapRock? 

CapRock Health System is required to collect your copay.

  • For patients with insurance, CapRock is required to collect a copay at the time of your visit.  If there is an out-of-pocket amount mandated by your insurance beyond the copay, we will not know that at the time of your visit but are required to bill you for it later.
  • For patients without insurance, we offer discounted rates as an option.  These prices and other details can be discussed with you 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

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. 

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. Please note that this does not apply to care received at urgent care facilities. 

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, urgent care, 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

If our services are in-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, who 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.

Out-of-network Billing

If our services 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, who 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.

Cash Pay Services

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

Does CapRock balance bill?

CapRock Health System does not “balance bill.”

  • 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.  
  • Similarly, CapRock does not balance bill at either urgent care facility 
  • 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 virtually all insurance plans now include copays, deductibles, and coinsurance, no matter the type of facility you choose, almost all visits will result in a patient having some out-of-pocket expense. When this occurs, our billing company will send a bill.
  • 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.