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Insurance Plans

For insurance questions not answered below or questions regarding your account, you may contact our Customer Service Call Center at (713) 520-4700.  Representatives are available to assist you Monday through Friday from 9:00 am – 4:30 pm.

We encourage our patients to communicate directly with their benefits managers to understand the details of their coverage and to relay limits and/or non covered benefits to our physicians and staff.

Medical Clinic of Houston strives to stay on top of the constant changes in the healthcare insurance industry. We participate with most major group insurance plans. Unfortunately, that does not include Cigna, nor most Qualified Health Plans (QHP), (i.e., plans offered through the healthcare exchange), HMO plans, or Medicare Advantage plans.

To verify plan participation please call (713) 520-4713.

Insurance

  • Insurance Accepted

    While our physicians participate with most insurance, your insurance policy is a contract between you and your insurance carrier. We do not guarantee payment of your claim, nor do we assume responsibility for meeting your insurance plans’ requirements for pre-authorizations, second opinions, or hospital stays. We will, of course, be happy to furnish you with any documentation needed to obtain necessary approvals or to resolve a disputed claim.

    To verify plan participation please call (713) 520-4713.

    Insurance Companies with whom MCH participates.

    • Aetna
    • Blue Cross Blue Shield
    • Evolutions Healthcare Systems
    • HealthSmart Preferred Care, Inc.
    • Humana
    • Independent Medical Systems
    • Integrated Medical Systems
    • Interplan Health Group
    • PPO Next
    • Private Healthcare Systems (PHCS)
    • Texas True Choice
    • Unicare
    • United Healthcare
    • USA Managed Care
  • Traditional Indemnity Insurance and Self-Pay

    Payment of applicable deductibles should be made at the time of your visit. We will submit a claim to your insurance (primary and secondary if applicable) carrier for direct payment to the Clinic of your insurance benefits.

    We make every effort to be aware of obligations under your plan for pre-authorization, referral authorizations, and other utilization management obligations in order to be able to provide the services you need based on your health status. Since your insurance policy is a contract between you and your insurance carrier, we do not guarantee payment of your claim, nor do we assume responsibility for meeting your insurance plans’ requirements for pre-authorizations, second opinions, or hospital stays.

    We will, of course, be happy to furnish you with any documentation needed to obtain necessary approvals or to resolve a disputed claim.

    Should you being paying cash, we accept payment by cash, check, VISA, Master-Card, Discover, and American Express for services rendered at the time of your visit.

  • PPO and POS Plans

    Payment of applicable deductibles and co-pays should be made at the time of your visit. We will submit a claim to your insurance (primary and secondary if applicable) carrier for direct payment to the Clinic of your insurance benefits. We make every effort to be aware of obligations under your plan for pre-authorization, referral authorizations, and other utilization management obligations in order to be able to provide the services you need based on your health status.

    Your awareness of your plan’s requirements will add a greater level of assurance that your plan’s obligations will be met which, in the long run, will benefit you. It is important for you to know that your insurance plan may not pay for all services provided at the Clinic. What services are covered is dependent on your plan’s benefits. You will be responsible for all services rendered that are considered non-covered, experimental, or deemed by your insurance company as not medically necessary.

  • HMO and Gated Plans

    If your health plan requires you to select a primary care provider (“PCP“) please contact your Plan Administrator to designate your MCH general internal medicine physician as your PCP at least 24 hours in advance of your visit.

  • Medicare

    Original (often called traditional) Medicare is a health insurance program administered by the U.S. government for people age 65 or older and for some disabled persons under 65. It is divided into two parts: hospital insurance (Part A) and medical insurance (Part B). We bill Part B insurance when services are rendered at the Clinic or by a Clinic physician.

    MCH physicians have chosen to be in the participating category of physicians in the Original Medicare program, which means your MCH physician will accept Medicare assignment.

    It is important for you to know that Medicare does not pay for all services provided at the Clinic. Medicare may determine your diagnosis does not qualify for coverage for certain procedures (e.g., limited coverage procedures) or that you have had a test too recently. You may be asked to sign a waiver [i.e., a Medicare Advanced Beneficiary Notice (“ABN”)] stating that you will be responsible for payment should Medicare deny payment.

    Medicare also does not pay for “non-covered” services, which are services that fall outside of the Medicare program. Physicians, whether “participating” or “non-participating,” can bill their usual fee for non-covered services. You will be responsible for full payment of non-covered services.

  • Medicare Replacement Plans

    Medicare Advantage plans are offered through various insurance companies and are NOT considered traditional Medicare.  The Medicare Advantage plan patients our physicians will accept* will be those patients covered by the Aetna Teachers’ Retirement Medicare Advantage plan (TRS.MA), effective January 1, 2013.

    Please be aware that the Clinic does NOT participate in Medicare Advantage (HMO or PPO) plans or accept Medicare Advantage patients. As an exception to this policy, the Clinic is in-network with and will see Aetna Teachers’ Retirement Medicare Advantage patients.

    *Some MCH physicians do make exceptions, please call and discuss your specific situation with your MCH physician.