OrthoTexas currently accepts the following insurance:

AARP Medicare Complete
Aetna HMO/PPO (Premier Care Network, Aexcel, and Marketplace Exchange Plans)
Aetna Medicare PPO/HMO
Aetna Texas Health Plan (excluding Knoll, and McKenzie)
BCBS PPO/POS/EPO/HPN
BCBS HMO (No My Blue/SW Health Resources)
BCBS Medicare HMO/PPO
BCBS Health Select
Beech Street PPO
Care Improvement Plus
ChampVA
Cigna HMO/PPO (NO Cigna CONNECT Marketplace/Exchange plans)
Cigna International
Cigna Local Plus
Cigna Open Access

Employer’s Health Network (EHN)
Evry Health
First Health/Coventry PPO
Galaxy Health Network PPO
Healthsmart GEPO/POS/PPO/NON-EPO
Humana Choice Care PPO
Humana Medicare Advantage HMO/PPO
IMS (Independent Medical Systems PPO)
International Health
Medicaid – Traditional (As secondary only – NOT Contracted with: Amerigroup, Chips, Cooks Children, Molina, Parkland Kids, Star Plus, Superior, Texas Choice)
Medicare – Traditional
Medicare Railroad
Molina Marketplace (HMO/PPO) Bronze, Silver, and Gold * (Fuller, Kouyoumjian, McKenzie, and Schwartz only) will see (HMO requires a referral)

PHCS/Multiplan
Plan Vista Pro
School Insurance
Scott & White Health Plan HMO/PPO/EPO
Tricare for Life (Medicare Supplement Only)
Tricare East/West Standard, Reserve, or Select
UHC Choice (Golden Rule)
UMR
Unicare
United Health Care PPO/HMO
United Health Care EPO (No Compass EPO or Methodist EPO)
United Health Care Navigate
United Health Care NexusACO
United Health Care Medicare Advantage PPO
WebTPA

*Individual insurance contracts can change frequently and some contracts allow for specific physicians only. Please contact your insurance plan or our office directly with questions and to verify your coverage.

Your Rights and Protections Against Surprise Medical Bills

When you get emergency care or are treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from balance billing. In these cases, you shouldn’t be charged more than your plan’s copayments, coinsurance and/or deductible.

What is “balance billing” (sometimes called “surprise billing”)?

When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, like a copayment, coinsurance, or deductible. You may have additional costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network.

“Out-of-network” means providers and facilities that haven’t signed a contract with your health plan to provide services. Out-of-network providers may be allowed to bill you for the difference between what your plan pays and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your plan’s deductible or annual out-of-pocket limit.

“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care – – like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider.

You’re protected from balance billing for:

Emergency services

If you have an emergency medical condition and get emergency services from an out-of-network provider or facility, the most they can bill you is your plan’s in-network cost-sharing amount (such as copayments, coinsurance, and deductibles). You can’t be balance billed for these emergency services. This includes services you may get after you’re in stable condition, unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services.

Certain services at an in-network hospital or ambulatory surgical center

When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers can bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers can’t balance bill you and may not ask you to give up your protections not to be balance billed.

If you get other types of services at these in-network facilities, out-of-network providers can’t balance bill you, unless you give written consent and give up your protections.

You’re never required to give up your protection from balance billing. You also aren’t required to get out-of-network care. You can choose a provider or facility in your plan’s network.

When balance billing isn’t allowed, you also have these protections:

You’re only responsible for paying your share of the cost (like the copayments, coinsurance, and deductible that you would pay if the provider or facility was in-network). Your health plan will pay any additional costs to out-of-network providers and facilities directly.
Generally, your health plan must:
Cover emergency services without requiring you to get approval for services in advance (also known as “prior authorization”).
Cover emergency services by out-of-network providers. What you owe the provider or facility (cost-sharing) on what it would pay an in-network provider or facility and show that amount in your explanation of benefits.
Count any amount you pay for emergency services or out-of-network services toward your in-network deductible and out-of-pocket limit.

If you think you’ve been wrongly billed

Contact our billing department at 972-395-2220.
Visit cms.gov/nosurprises/consumers for more information about your rights under federal law.
For more information about your rights under Texas law, contact 888/973-0022.