Insurances Accepted & Billing
At Houston Thyroid and Endocrine, we have competitive cash rates for our uninsured patients and out-of-network patients. The patient is responsible for knowing what is covered as a copay or deductible and ensuring proper insurance coverage.
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List of Insurances for which we are In-Network
Insurance Contracts are always changing, if you have any questions, please contact the office for specific instances.
Updated 10-16-2024
Aetna Commercial/Whole Health (but not not "Kelsey Seybold QHP" marketplace plans)
Aetna Medicare Advantage***
Aetna Premier HMO/Prime HMO/Value PPO -(Referral may be required through insurance)
Aetna Select***
Ambetter Commercial/Marketplace Plans- but note, we are OUT of network with Ambetter Core/Select/Value Plans (which require referrals).
Blue Cross Blue Shield Essentials/Health Select/Premier HMO - (Referral may be required through insurance)
Blue Cross Blue Shield HMO***/POS
Blue Cross Blue Shield PPO/Blue Choice
Blue Cross Blue Shield Medicare Advantage PPO
Blue Cross Blue Shield Medicare Advantage HMO (Referral required through insurance)
Cigna Commercial
Cigna Local Plus
Cigna Healthspring Medicare Advantage
Cigna Preferred Medicare HMO ***
Cigna Preferred Savings Medicare HMO (Referral required through insurance)
Cigna True Choice Medicare PPO
Cigna Alliance Medicare HMO ***
CHAMPVA
Community Health Choice Marketplace only
Community Health Choice HMO Marketplace only
First Health Insurance
Freedom Life Insurance (Televisits not covered)
GEHA
Great West- Cigna
HC Hwys Logix/Sync (including MNA Neuro)
Humana Gold Plus HMO (Referral may be required through insurance)***
Imagine Health
Memorial Hermann HMO
Memorial Hermann Care/Catastrophic
Memorial Hermann Select HMO/PPO
Multiplan PPO
Oscar Health PPO
Oscare Health Medicare Advantage
Oscar Health HMO (Referral required through insurance)
Palmetto GBA (Railroad Medicare Insurance)
Provider Partners Health Network
PHCS PPO
Sana Benefits
Tricare Standard (not Prime)
Triwest***
UMR
United Healthcare PPO (no "QHP" marketplace plans, no charter plans )
United Healthcare Commercial Products
United Healthcare Medicare Advantage -
(Referral may be required through insurance)
Wellcare PPO/HMO***
***Insurance That Require Referral from PCP
BCBS HMO (Prefix: ZGN, T2U,VER, ZGI, ZGZ, JEA)
Triwest
Humana Gold Plus HMO
WellCare - Out of Network (Needs referral + Needs Pre-Authorization)
Aetna Select
Aetna Medicare HMO
UHC Nexusaco
Cigna Medicare HMO
Cigna HMO
INSURANCES NOT ACCEPTED
Molina (Medicaid)
Ambetter HMO
BCBS that starts with T2G
UHC where group number is TXONEX (Out of Network)
UHC where group number is TXSTPL - STARPLUS (medicaid) or DSNP (medicaid)
Ameriben Medicaid
Bright Healthcare
Any form of Medicaid
Devoted
Community Health Choice HMO (this is medicaid)
Aetna CVS QHP - HMO
Aetna KELSEY SEABOLD
Superior Health (Medicaid)
Aetna CVS QHP
What is a co-pay and what is a deductible? They both involve payment on the part of the insured, but the amount and frequency differ.
KEY TAKEAWAYS
Co-pays and deductibles are both features of most insurance plans.
A deductible is an amount that must be paid for covered healthcare services before insurance begins paying.
Co-pays are typically charged after a deductible has already been met. In some cases, though, co-pays are applied immediately.
Some plans have a separate deductible for prescription drugs or other services. With family plans, there are often two deductibles: for an individual, and for the whole family.
WHAT IS A COPAY?
A co-pay, short for co-payment, is a fixed amount that a healthcare beneficiary pays for covered medical services. The remaining balance is covered by the person’s insurance company.
Co-pays typically vary for different services within the same plans, particularly when they involve services that are considered essential or routine and others that are considered less routine or in the domain of a specialist.
Co-pays are typically lower for standard doctor visits than for seeing specialists. Co-pays for emergency room visits tend to be the highest.
WHAT IS A DEDUCTIBLE?
A deductible is a fixed amount that a patient must pay each year before their health insurance benefits begin to cover the costs.
After meeting a deductible, beneficiaries typically pay co-pay - a certain percentage of costs—for any services covered by the plan. They continue to pay the co-insurance until they meet their out-pocket maximum for the year.
IS A COPAY SAME AS DEDUCTIBLE?
No, but the two terms are often confused.
A co-pay is a fee that you pay when you receive healthcare services, such as visiting a doctor or picking up prescriptions. Your health insurance company will pay part of this cost, and you will pay the rest. A deductible is a set amount that you must meet for healthcare benefits before your health insurance company starts to pay for your care. Co-pays are typically charged after a deductible has already been met. In most cases, though, co-pays are applied immediately.
WHAT IS AVERAGE COPAY AND DEDUCTIBLE?
This will depend on your personal circumstances, but a high-deductible plan is generally regarded as any plan that has a deductible of $1,400 or more for an individual or $2,800 or more for family coverage. Plans with lower deductibles will have higher monthly premium costs.
Though high-deductible plans usually cost you more in out-of-pocket expenses, they can have advantages that offset that cost. Generally, high-deductible plans qualify for a Health Savings Account, which can help you to save for and manage healthcare costs.