Participating Insurance Companies

WE ARE ALWAYS ADDING NEW INSURANCE PLANS. THIS IS NOT A COMPREHENSIVE LIST. PLEASE CALL THE OFFICE TO DOUBLE-CHECK.

Aetna

Aetna PPO
Aetna EPO
Aetna HMO
Aetna Managed Care
Aetna – All Texas narrow network plans
Aetna Premier Care Network
Aetna Premier Care Plus (“ACPN” – narrow networks)
Texas Health Aetna – PCPs

Ambetter

Superior Ambetter Commercial Marketplace EPO
Ambetter value plans

Baylor Scott and White

BCBS

BCBS PPO (BlueChoice Network)
BCBS EPO (BlueChoice Network)
BCBS PPO/POS plans offered through Blue Card (out of state plans)
BCBS HMO** (Blue Essentials)

Cigna

Cigna PPO
Cigna POS
Cigna EPO
Cigna OAP
Cigna HMO**
Cigna Network
Cigna Great West Plan
Cigna LocalPlus

Coalition America (Formerly NPPN)

Coastal Comp Workers Comp

FedMed – PPO

First Health

First Health/Coventry Network – PPO
First Health/Coventry Network – WC

Friday Health Plan

Friday Health Plan – EPO/PPO (Dallas)
Friday Health Plan – EPO/PPO (Rural)
Friday Health Plan – EPO/PPO (Tarrant)

Healthcare Highways

Healthcare Highways
Healthcare Highways ACO
Healthcare Highways Commercial

Galaxy

Galaxy Healthcare PPO
Galaxy Medical Savings Plan

Healthsmart

HealthSmart ACCEL
HealthSmart GEPO
HealthSmart PPO
HealthSmart/Interplan Health Group WC

Humana

ChoiceCare (Humana) – Concentric (Humana Preferred)
ChoiceCare (Humana) – Medicare Advantage HMO** (PCP)
ChoiceCare (Humana) – Medicare Advantage PFFS
ChoiceCare (Humana) – MedicareChoice PPO
ChoiceCare (Humana) – PPO
Humana Choice Care PPO
Humana MA ACO

IMS PPO

Medicare

Aetna Medicare Advantage PPO
Aetna Medicare Advantage HMO
Aetna Medicare Prime HMO* (Eligibility determined by Aetna only, dependent on hospital privileges)
Superior Medicare Advantage HMO**
BCBS Medicare Advantage PPO
BCBS Medicare Advantage HMO**
Care N Care Medicare Advantage
CMCHP – Medicare Advantage
First Health/Coventry Network – Medicare Advantage PPO
Humana Medicare Gold Plus HMO**
Humana Medicare Choice PPO
Humana Medicare Gold Choice PFFS
Mutual of Omaha Medicare Advantage
Texas Bluebonnet – Medicare Advantage
Wellcare Medicare HMO

Molina

Molina – Marketplace (Dallas-PCP)
Molina – Marketplace (Rural-PCP)
Molina – Marketplace (Tarrant-PCP)

MultiPlan

MultiPlan Auto Medical
MultiPlan Complimentary Network
MultiPlan Workers Compensation

Oscar Insurance

PlanVista – PPO

Texas Bluebonnet

Texas Bluebonnet – EPO/HMO/PPO

UA TexanPlus Medicare Advantage

UAM TexanPlus ACO

United Healthcare

United Healthcare – HMO**/PPO
United Healthcare – Secure Horizons/Evercare (Dallas)
United Healthcare – Secure Horizons/Evercare (Rural)
United Healthcare – Secure Horizons/Evercare (Tarrant)
United Healthcare PPO
United Healthcare POS
United Healthcare EPO
United Healthcare HMO**

USA MCO – GPG

USA MCO Workers Compensation – GPG

Value Based Care (VBC) Program – Aetna Medical Neighborhood
Wellcare

WellCare HMO ACO

** Requires Referral Authorization Letter/Referral From PCP

FAQ on Insurance

Why do I have a large insurance balance on my EOB?

Typically you will have a large insurance balance if insurance has denied a claim and we need to resubmit the claims with provider notes to prove medical necessity. When claims are being resubmitted, insurance can be slow with processing. Although rare, from time to time we may need to adjust coding if errors have been made or add diagnoses to help meet medical necessity. This can take as little as a few weeks to a few months to complete processing depending on insurance response times. Please check with your insurance regarding claim processing times. You can also see when claims are processed on your insurance portal. If neither of these options work please check back with our billing department within 4-6 weeks after claim submission.

Why do I have a large patient balance?

This is highly unusual as most patients have excellent coverage of coaching visits, but this can vary similar to an insurance balance. We try our best to get an estimate on the cost of services from your insurance prior to your appointment, however, we are limited by the representative we speak with and the information provided on the insurance portals. We are only given an estimate of costs and coverage can vary once claims are submitted. We may be told that a copay applies, when in fact the coverage goes towards your deductible or coinsurance. We always recommend that you touch base with your insurance to verify coverage prior to any service being rendered. Final determination of costs is always made by your insurance carrier once a claim is submitted, not by the medical practice.

What is the difference between coverage for seeing an MD/PA vs the other Vitality coaches?

Coverage for an MD or Physician Assistant visit is considered a medical office visit and the cost is similar to any other specialist visit. This could be a copayment amount or a coinsurance amount that applies towards your deductible. Every plan is different and coverage can vary depending on which plan you have chosen. A new patient appointment can be a higher out of pocket cost than a follow up visit based on your covered benefits.

Coaching visits (such as visits with dietitians, personal trainers, mindset coaches and counselors) are all considered counseling visits.

Whether these are covered are dependent on your insurance plan, but usually most patients do have at least ONE visit covered. Clinician visits are billed two ways with differences described below:

99402/99403/99404 (Dietary Counseling)

96158 (Behavioral Intervention)

What is CPT code 99402/99403/99404?

Usually covered at 100% (no copay; does not go towards or depend on your deductible)
Usually free for you (because insurance pays for the visit)
The number of visits covered varies by insurance plan, some cover “unlimited” visits and some cover a defined number of visits (ie 10 visits).

What is CPT Code 96158?

Sometimes comes out of the patient’s deductible if patient has not met the maximum out of pocket yet
Often has a copay such as $25-30

We will always try to bill your coaching visits with the 99402/99403/99404 CPT code first when appropriate, but based on what is discussed at the appointment and number of visits covered by your insurance plan for that code, that is not always possible.

What is the difference between a copay vs deductible vs coinsurance?

A copay is a set rate that you pay for doctors visits and other types of care. This amount is set based on your specific plan/coverage. For example, this could be $25 per appointment.

A coinsurance is a percentage of costs you are responsible for after you’ve met your deductible. If a coinsurance applies for your visit, instead of a copay, you will be responsible for 100% of your medical cost until your deductible has been met. Once your deductible is met you will pay a percentage of costs set by your insurance until your out of pocket is met.

Example: 80/20. Your plan will pay 80% and your out of pocket will be 20%.

A deductible is the amount you pay for out-of-pocket costs for your covered health care before your plan begins to pay. You should always check with your insurance carrier to verify if a deductible applies towards your healthcare benefits. This could result in you having to pay out of pocket for your visit.

I was told my visits are covered at 100% but now I have to pay X amount. Why?

When we call insurance companies to get information on cost and coverage, it is an estimation, not fact or a final answer. We are limited to who we speak with and the information provided on the insurance portals. We may be told that a copay applies, when in fact the coverage goes towards your deductible or coinsurance. Final determination of costs is always made by your insurance carrier once a claim is submitted, not by the medical practice. We always recommend that you touch base with your insurance to verify coverage prior to any service being rendered.

How much is a new patient visit?

The cost of a new patient visit varies depending on your insurance plan. You may have to pay a copay, coinsurance or the full deductible amount (if you have not met your deductible yet). If you are required to pay the full deductible amount your new patient visit could range from $175-$300 depending on the contracted rate we have with your insurance and follow up medical visits are between $100-200.