Established Reimbursement Schedule
Frequently Asked Questions

What is ERS?

ERS stands for "Established Reimbursement Schedule" and is a database of
reasonable reimbursements to healthcare providers based on the services they
have rendered to you. This reimbursement is adjusted for geographical variations
to keep it fair to both the provider and the payor. The calculated reimbursements
reward the provider for their work at a rate that is common and consistent for
providers of the same type delivering the same services.

Why is my doctor billing me a high fee?

You have received services from an "out-of-network" healthcare provider. This means
that your doctor or hospital has no contractual agreement with your insurance plan
to treat you at a certain price. Your insurance plan has used information about fees
other doctors or hospitals in your neighborhood get paid for the same services you
received, and has reimbursed your healthcare provider at that same rate.

This is a normal practice for all healthcare benefit plans, and is based on the fact
that insurance plans calculate their premiums according to "reasonable" payments
for healthcare services.

If your healthcare provider is billing you in excess of a reasonable reimbursement,
discuss this with your physician or hospital. Your provider may be willing to adjust
your charges to be the same as others pay. As an educated consumer, you may
choose in the future to make the same or different choices when selecting your
healthcare provider.

Is ERS a PPO or HMO network?

No, ERS is not a network. ERS is a fee schedule. ERS contains information about
reasonable reimbursements for all medical services in all geographical areas.

How were the ERS fee amounts determined?

ERS reimbursements were computed using information from multiple sources, both
public and private, about reimbursements made within the past 12 months for all
type of healthcare procedures. Hundreds of millions of payments were evaluated to
derive a benchmark reimbursement for each geographical area. Hospital inpatient
reimbursements were computed using self-reported cost to charge ratios.