Generic selectors
Exact matches only
Search in title
Search in content
Search in posts
Search in pages

Insurance

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 you to understand your insurance coverage benefits or exclusions (your employers’s human resource / benefits manager or your health insurance company’s help desk are typical resources).  Please relay these to your MCH physicians’ staff.

  • Understand Your Insurance Plan's Benefits

    Understand if your plan has any:

    • Restrictions or limits in coverage
    • Non covered benefits
    • Out-of-Network benefits
    • Special criteria for use with physicians and other services provided in the Clinic
    • Pre-authorization requirements
  • Communicate Your Insurance Plan's Benefits

    We encourage you to communicate directly with your employers’ human resource / benefits manager or your health insurance company’s help desk to understand the details of your coverage.

    Please relay these details to your MCH physicians’ staff.

    If you have additional questions after conferring with your health insurance company, please call MCH at  (713) 520-4713.

Plans in which MCH participates are listed below. If your plan is listed, MCH is a participating provider. If your plan is not listed and you have determined you have out-of-network benefits, you may choose to access care utilizing those out-of-network benefits.

Accepted Insurance Plans

  • Aetna Plans

    • HMO
    • QPOS
    • Elect Choice
    • Managed Choice POS
    • Choice POS II
    • Select
    • Open Access
    • Open Choice PPO
    • National Advantage
    • EPO Standard Plans (No Limited EPO Plans from Memorial Hermann)

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

  • Anthem (Blue Cross Blue Shield) Plans

    • POS
    • PPO
    • EPO

    If a suitcase icon with the word PPO is displayed on the back on your insurance card, MCH physicians are participating physicians.

    What is the “PPO in a suitcase” logo?
    You’ll immediately recognize BlueCard PPO members by the special “PPO in a suitcase” logo on their membership card. BlueCard PPO members are Blue Cross and Blue Shield members whose PPO benefits are delivered through the BlueCard Program. It is important to remember that not all PPO members are BlueCard PPO members, only those whose membership cards carry this logo. Members traveling or living outside of their Blue Plan’s area receive the PPO level of benefits when they obtain services from designated PPO providers.

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

  • Blue Cross Blue Shield Plans

    Blue Cross Blue Shield of Texas – including Anthem

    (Call for other states)

    • HealthSelect  (your insurance card must show your MCH physician as your assigned PCP)
    • PPO
    • POS
    • ParPlan

    If a suitcase icon with the word PPO is displayed on the back on your insurance card, MCH physicians are participating physicians.

    What is the “PPO in a suitcase” logo?

    You’ll immediately recognize BlueCard PPO members by the special “PPO in a suitcase” logo on their membership card. BlueCard PPO members are Blue Cross and Blue Shield members whose PPO benefits are delivered through the BlueCard Program. It is important to remember that not all PPO members are BlueCard PPO members, only those whose membership cards carry this logo. Members traveling or living outside of their Blue Plan’s area receive the PPO level of benefits when they obtain services from designated PPO providers.

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

  • HealthSmart Preferred Care

    • PPO

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

  • Humana Plans

    • Choice Care
    • POS
    • PPO
    • Preferred POS
    • Preferred PPO
    • NPOS Open Access

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

  • PHCS Multi Plan

    • POS
    • PPO

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

  • UNITED HEALTHCARE Plans

    • Choice
    • Choice Plus
    • PPO
    • Select
    • Select Plus
    • EPO (Navigate PCP requires a designated MCH Physician)

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

  • Medicare

    • Traditional Medicare
    • Medicare Railroad
    • Aetna Teachers’ Retirement Medicare Advantage plan (TRS.MA), effective January 1, 2013

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

    Traditional (also known as Original)  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.

    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 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.

While our physicians participate with most insurance plans, your insurance policy is a contract between you and your insurance carrier. Although Medical Clinic of Houston strives to stay on top of the constant changes in the healthcare insurance industry, 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.

  • Insurance Plans NOT Accepted

    We participate with most major group insurance plans except the following:

    • Cigna
    • Most Qualified Health Plans (QHP) i.e., plans offered through the healthcare exchange
    • Most HMO plans
    • Medicare Advantage plans

Additional insurance details

  • 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)

    Medicare Advantage plans, offered through various insurance companies, are NOT considered traditional Medicare.  

    The Clinic does NOT participate in Medicare Advantage (HMO or PPO) plans or accept Medicare Advantage patients. 

    (The sole Medicare Advantage plan our physicians accept* are patients covered by the Aetna Teachers’ Retirement Medicare Advantage plan “TRS.MA”.)

    *Please call and discuss your specific situation with your MCH physician.

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