Insurance Accepted
Insurance Plan’s Provider Network
Our practice is contracted with all of the major insurance carriers and many others. However, many insurance plans only offer a narrow network of providers, so it’s important for you to confirm that your provider is in-network with your plan.
Texas Statute prohibits delays in patient medical care. If your plan excluded our practice and left you without access to a provider, request they add us to your network prior to your visit.
Primary Care Provider
Your insurance policy may require you to designate a Primary Care Physician (PCP) and see your PCP for referrals to specialists. You are allowed to change your designated PCP throughout the year.
Your policy may not require you to designate a PCP, but automatically designated one for you.
You may not know you have a designated Primary Care Physician, so it’s important to check with your insurance in case one was automatically assigned for you.
Medical Billing Terms 101
- Insurance Premium:
- The monthly fee you and/or your company pay the carrier. It does not guarantee payment of your medical bill. You pay more each year for less coverage.
- CPT Codes:
- Every medical service has a unique number code for billing purposes. There is not a CPT code or flat rate per "visit". In the course of delivering preventive medical service, your provider may need to address an uncontrolled problem. The evaluation, assessment, and treatment of a problem is not preventative; it's a different code, seperate service, and therefore an additional charge. An itemized claim lists each service (CPT code) provided during the visit. Your carrier may cover none, some, or all of the services from your visit.
- Balance (Patient Responsibility):
- The final amount you owe. The services, or portion of services, your carrier did not pay for. This is your responsibility. This does not include the copayment (also your responsibility).
- Charge Rate:
- The “retail” price for a service. AKA: Out-of-network rate (fictitious; insurance fabrication). In the past, insurance companies coerced patients to buy insurance by suing physicians to charge patients the full charge rates if they did not have insurance. See two actual discount rates below.
- Contracted (In-Network) Rate:
- Discount price the carrier agrees to pay for our service. The carrier sets this price and pays less every year.
- Direct Pay Rate:
- Discount price you pay for our service without involving a third party in payment. The lowest rate; cutting insurance out of the transaction saves both parties.
- External Service Charges:
- If you receive a lab, diagnostic test, or imaging bill- please contact that company about their bill.
- Capitation:
- Payment arrangement of a preset amount over a specific period for healthcare services. The "membership fee" covers unlimited medical services specified.
PLEASE NOTE:
We’re honored you have entrusted us with your family’s health.
Our practice focuses solely on providing every patient with the highest standard of medical care based on scientific research and evidence. We do not select care based on your insurance plan coverage, but work with you to keep costs low.
Our practice has no association with diagnostic labs, imaging centers, pharmacies, or specialists. Our clinic does not sell retail products or medications, and we do not perfom elective or cosmetic procedures. We do not benefit from or provide / recommend medically unecessary services.
If you feel like you were overcharged or prefer following medical advice from your insurance carrier — its important for you to find another healthcare provider that you trust and certainly value enough to pay.