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The Emergency Group, Inc., 770 Kapiolani Blvd., Suite 705, Honolulu, Hawaii 96813
About Billing & Insurance
Participation with an insurance plan means that we have signed an agreement with the insurance company to abide by their rules, and accept their fee schedule for payment. If you have a deductible or a co-payment, we are bound by contract to bill you for that amount. At TEG, we try to participate with nearly all major insurance plans in Hawaii, including Medicare, Medicaid, HMSA, and many others.
If we do not have a participation agreement with your insurance, you as the responsible party will be billed for any balance on your account. Non-participating insurance companies have no obligation to pay TEG. In that situation, their agreement is with you and, they determine how much they will pay. Their check will usually be sent to you. If they pay us instead, we will send you a refund for what you have paid us.
Did You Pay Queen's
If you already made payment to The Queen's Medical Center (QMC), you might believe that our physician was already paid. No part of your payment to QMC is forwarded to the emergency physician. The Emergency Group, Inc. is a separate entity from QMC, and we must bill separately for our physician services.
We are contracted by the medical center to staff the emergency department with our physicians. Your bill from The Emergency Group, Inc. is for emergency physician services only and is separate from The Queen's Medical Center. You may receive a separate bill from Queen's and/or other physicians who were involved in your care.
How The Bill Is Calculated
Medical billing is extremely complex. In general, any service by a physician is listed as a code defined in the Current Procedural Terminology (CPT) manual of the AMA. This includes 5 levels of service (depending on severity) for emergency department evaluation & management and other procedures. Relative values are assigned to each code by Medicare (and other plans) depending on the work value of the procedure.
The fee for each procedure corresponds directly to the assigned relative value of each code. If we have a participating agreement with your insurance plan, we must accept their fee schedule and payment whether or not they correlate with assigned relative values.