Insurance Information

Southwest Dermatology and Vein accepts most major insurance plans. To find out if we accept your plan, contact our office at (512) 444-7208.

Insurances accepted as of August 2019:

  • AARP Medicare Complete
  • Aetna
  • Aetna HMO*
  • Aetna Whole Health
  • Allied National, Inc.
  • Ambetter
  • Amerigroup Medicare Advantage (Amerivantage)
  • Ascension Smart Health
  • Blue Cross Blue Shield PPO
  • Blue Cross Blue Shield HMO & Health Select*
  • Blue Cross Blue Shield Medicare Advantage
  • BeechStreet Network
  • Boon Chapman
  • Care Improvement Plus

*Requires insurance referral from the PCP

  • ChampVA
  • Cigna PPO (Except Cigna Local Plus)
  • Cigna HMO*
  • CONNECTED Senior Care Advantage
  • FirstCare Health Plans
  • First Health Network
  • GEHA
  • Golden Rule
  • Healthcare Highways
  • Humana
  • Humana HMO & Gold Plus HMO*
  • Humana Medicare Advantage
  • Medicare (Traditional and Railroad)
  • Meritain Health
  • Multiplan Networks

 

  • Multiplan Medicare Advantage
  • Oscar
  • PHCS Networks
  • QVI Risk Solutions
  • Scott & White Health Plan (SWHP)
  • Sendero/ Ideal Care
  • Seton Health Plan/ Smart Health
  • Tricare Standard and Tricare for Life
  • Tricare Prime*
  • UMR
  • United HealthCare
  • United HealthCare HMO*
  • United Healthcare Medicare Advantage
  • Web-TPA
  • WellCare
  • Wellmed Networks

Frequently Asked Questions

What is the difference between in-network and out of network?
In-network refers to insurances with whom we are contracted; thereby providing services at set rates. Out of network refers to insurances with whom we are not contracted.

How do I know if my insurance is in-network?
By calling your insurance benefits department using the phone number on the insurance card. They will be able to confirm your specific policy’s network participation status.

Can I be seen if I my insurance is not in-network or if I do not have insurance?
Definitely. You will be considered private pay and will pay for services at the time they are rendered. If you are filing out-of-network, we will provide you with any information needed to file your claim. Each individual insurance plan has its own method for processing out of network claims; you will have to contact your insurance company directly for details.

I am a private pay patient, how much will I have to pay?
At minimum, you will be billed for an evaluation and management service. The pricing is based on the standard for the dermatology industry and for this region. The cost of your evaluation and management service is determined by the physician’s assessment of your individualized medical requirements and can range from $90.00 to $150.00. Any treatment you may require during your initial visit will be an additional cost which can be discussed with you prior to treatment.

Do I need a referral to be seen at your office? ONLY if your insurance requires it.
While most insurance companies do not require a referral, some specific policies (in particular HMO’s) do require them. If your policy requires you to have a referral and you do not have one, the insurance company will not approve services, therefore, we will collect private pay rates at the time of your visit. If you are unsure if your policy requires a referral, contact your insurance benefits department or insurance company directly.

How do I obtain a referral? (For Insurances that require a referral)
By calling your primary care physician. Your primary care physician will submit a referral authorization request on your behalf to your insurance company. Please allow enough time for the completion of the referral process prior to making your appointment.

My insurance is in-network, how much will I have to pay?
Depending upon your specific policy, the insurance may require you to pay the specialist copay and any unpaid annual deductible and coinsurance amounts. The insurance company will determine your final patient responsibility.

I paid my copay at the time of my appointment, why do I have a balance on my account?
For most insurances, your copay applies to the evaluation/consultation portion of your visit. Any procedures/treatments performed during your visit, may apply towards any out of pocket costs according to your particular insurance policy. It is always best to view your explanation of benefits provided to you by your insurance company to explain why you have a balance. If you still have questions, we will gladly assist you as best as we can.

How do I know my deductible and coinsurance amounts?
By calling your insurance benefits department using the phone number on your insurance card. They will inform you of your benefits based upon your specific, individualized policy. If you still have questions, we will gladly assist you as best as we can.

Copay is the fixed amount you must pay for a covered health care service. Copays are due at the time you receive a health care service. Copay amounts vary depending on your health insurance plan and are due at the time you receive your health care service.

Coinsurance refers to your share of the costs of a health care visit and is calculated as a percentage of the amount of a service. You are responsible for paying the full amount of your coinsurance and your deductible charge.

Deductible is the amount you pay for covered health care services before your insurance plan starts to pay. Deductibles do not always apply to all health care services. For this reason and to avoid unwanted billing surprises, you should ask your insurance company for a list of covered services.

Out-of-pocket maximum/limit. The most you have to pay for covered services in a plan year. After you spend this amount on deductibles, copayments, and coinsurance, your health plan pays 100% of the costs of covered benefits.