Health Insurance

Accepted Insurance 

 

We accept many of the major insurance plans in our area including Medicare.  The quickest way to find out if we accept your insurance is to call us or fill out the contact information form here.  Here are some of the insurance plans we cover (although not all of them are listed):

  • Aetna

  • Blue Cross / Blue Shield of Texas

  • Cigna PPO/OAP

  • Humana PPO

  • Prime Health PPO

  • Superior ​

  • Tricare

 

The above list includes just some of the insurance plans we take.  If you do not see your plan, please call us at 956-412-2836 to inquire about your plan.

Please bring your insurance card with you every visit.  We will make a copy of it for your medical record your first visit, but are required to check it frequently as part of our contract with insurance carriers as a way to prevent fraud.

Copays and Coinsurance

 

The patient is expected to present an insurance card at each visit. All copayments, coinsurance, and past due balances are due at time of check-in unless previous arrangements have been made with a billing coordinator. We accept cash, check and most major credit cards. 

Insurance Claims

 

Insurance is a contract between you and your insurance company. However, with your written permission, we are happy to bill your insurance company as a service to you . In order to properly bill your insurance company we require that you disclose all insurance information including primary and secondary insurance, as well as, any change of insurance information. Failure to provide complete insurance information may result in patient responsibility sometimes up to the entire amount billed. Although we may estimate what your insurance company may pay, it is the insurance company that makes the final determination of your eligibility and benefits. 

​Understanding Billing & Insurance Terms

 

Sometimes billing and insurance terms can be a language of its own. We hope the definitions of commonly used terms below will help regarding your healthcare billing and insurance claims.

Copay 

A copay is the fixed dollar amount a patient pays for covered health care.  Often times, there are different copays depending on whether you are seeing a primary care provider or a specialist.

 

Coinsurance

Coinsurance is the patient's share of the costs of a covered service, calculated as a percent of the allowed amount for the service. Example: If the plan’s allowed amount for an office visit is $100, and the patient co-insurance amount is 20%, the 20% payment of $100 would be $20 in addition to any copay you may have.

 

Deductible 

A deductible is the amount you must pay for covered services before the insurance starts covering your cost.  Usually preventative services such as wellness exams and immunizations such as the flu shot are covered without requiring you to pay a deductible.  However, it is always best to contact your insurance company if you are unsure of your coverage, please contact your insurance company.

 

When you are insured on a family plan, please review the type of deductible-traditional or aggregate. Health plans with traditional deductibles have 2 separate deductibles: an individual and a family deductible. The individual deductible allows each member of a family to receive benefits from the insurance company before the family deductible has been satisfied.

If your family is on an aggregate deductible plan, the entire family needs to satisfy the deductible before any members of the family receive benefits. This type of plan is usually seen in high deductible plans tied to a health savings account.

 

Out of Pocket Limit

This is the most a you could pay during a covered period (usually 1 year) for your share of covered services. If you are unsure of your limit, please contact your insurance company with questions.

 

In-Network

“Participating” or “In Network” providers are those contracted with your carrier. You pay a lower co-insurance and deductible when they use an in-network provider. We do our best to verify coverage prior to your visit but your carrier states it is your responsible to verify you are scheduled with an “in-network” provider by checking online or calling your carriers customer service line listed on the backside of your insurance card.

 

Out-of Network

If a provider or pharmacy is not listed as an “in-network” or “participating provider”, you will  have a higher out of pocket cost for the service(s) rendered. Please contact the customer service number on the back of your card for the exact amount. The deductible and co-insurance will be higher than in network providers.