Texan Eye accepts most types of health insurance and a wide variety of Routine Vision plans. Whether you have Medicare, managed care, or private insurance, it is likely that your insurance will cover all or some of the services you receive. As insurance policies vary greatly, we recommend that you check with your insurance carrier regarding the details of your coverage. If you are a member of a Health Maintenance Organization (HMO), you will most likely need a referral from your Primary Care Provider (PCP) prior to being seen.
As a guide for our patients, Texan Eye has provided some common insurance definitions in the table below. This information should be used only as a guide and specifics regarding your medical or vision insurance should be requested directly from your specific insurance provider.
| Medicare/Medicaid
Managed Care Plans | Many Medicare and/or Medicaid plans have moved to managed care plans i.e. Medicare Advantage plans. While you may have a Medicare and/or Medicaid card, this is not your primary insurance card. Your primary insurance card that is needed to bill your visit correctly may be a Blue Cross Blue Shield, United Healthcare, Amerigroup or another insurance company. Please provide that card to the front desk if you are aware of your participation with a managed care plan. |
| PPO | PPO plans offer the choice of choosing a healthcare provider. You do not need to choose a Primary Care Provider (PCP) or obtain a referral to be seen. If you choose to see an in-network provider, you would pay your typical copays, co-insurance and a deductible, if applicable. If you choose to see an out-of-network provider, your costs may include higher copays, co-insurances and a higher deductible. |
| HMO | HMO plans do not give you the option to choose your healthcare provider. You must establish with a Primary Care Provider (PCP) who will refer you to a specialist if needed. Visits without a referral are considered unauthorized and responsibility of payment falls on the patient. With a referral, you would be responsible for your copays, co-insurance and deductible, if applicable. The patient is ultimately responsible for contacting their PCP, obtaining and bringing to their initial visit all referral paperwork which ensures that the visit will be processed within the policies that the patient has agreed to with their insurance company. |
| Routine Vision Benefits | Depending on your plan, this may be a benefit you receive from your insurance company. If you know that your plan offers vision benefits, there may be a third party administrator for the vision. Please make yourself aware of who administers your routine vision benefits services due to the fact that it may not display under your health care benefits. |
| Deductible | A deductible is the amount you are responsible for before your insurance company starts to pay for your medical services. |
| Co-Pay | A copay is the set dollar amount you pay upfront for medical services. |
| Co-insurance | A co-insurance is the percentage of the total cost of your medical service. Your co-insurance usually starts after you have met your annual deductible. |
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