The free-standing ERs are not allowed to accept Medicare or Medicaid, for example. Many of the facilities are concentrated in urban areas and not in some of the underserved rural parts of Texas, according to the Dallas Morning News. There is also the matter of cost, which is not always transparent and not on the forefront of the minds of people who use the freestanding ERs for life-threatening medical emergencies. Recent regulations require these types of facilities to provide patients with written confirmation of their insurance status. On the other hand, the emergency facilities have the virtue of convenience. One generally does not endure the kind of long waits typical at a hospital ER.

The Wichita Fall Times Record News notes one new free-standing ER located in that community that is making a go at a market that has not been kind to other attempts to establish such facilities. Two companies, run by Neighbors Emergency Center and Select ER, opened independent ERs in the spring of 2016 only to close them after a year and a half of operation. The new facility, owned by ER Now, is run by a group of 12 local doctors. Its main selling point is that its physicians are part of the local community. However, the new stand-alone ER also is attractive from a cost standpoint, so long as the patient has private insurance.

Essentially, the ER Now facility does not engaged in a practice called "balanced billing" in which a healthcare provider attempts to collect on the amount that an insurance company pays and the total cost of the bill. Also, the private ER accepts all major insurance. Whether the business model will help the year-old ER to stay open when the two previous ones failed remains to be seen.