• insurance

Insurance Changes to Individual Policies

 

Both Blue Cross Blue Shield of Texas and Humana eliminated their PPO individual plans in 2016.  This does not affect PPO plans that are offered by employers.  It also does not affect PPO plans that were created before March 23, 2010, and have not been altered.  Those are considered “grandfathered”.  If you do not select another health insurance, Blue Cross Blue Shield and Humana will automatically move you to their HMO Products. 

 

 

With the many changes in  the healthcare industry,  please contact your insurance company to confirm that Beansprout Pediatrics tax ID # 271766809 is an "in-network provider" for your particular plan.  It is the parents responsibility to verify whether or not your doctor is an in-network provider for your insurance 

 

 

 

 

 Insurance plans  Beansprout accepts 

Blue Advantage HMO & Blue Advantage Plus HMO: Beansprout Pediatrics is participating in these plans.  Prior to seeing any specialist, per your plan contract, you are required to first see your primary care provider for the medical issue. This allows Beansprout to obtain referral approval to see the recommended specialist. This process may take up to 7 days. These plans have a very limited number of specialty providers in network. With very few specialists in the network, obtaining referrals for specialty care, like cardiology, and gastroenterology, is very difficult. this may negatively impact the care we recommend to our patients.  Blue Advantage Plus HMO is similar to the HMO, but has out of network benefits, Therefore, you may see a Beansprout provider, although you will have higher out of pocket expenses because we are out of network.

 

United Compass Products:  Beansprout Pediatrics is participating in this plan.  United Compass is a closed network; therefore there may be limited specialists in this network.  Please note, this plan limits hospital services to only St. David’s facilities.  Seton is not participating, this includes all pediatric specialists through Dell, Specially for Children

 

Aetna EPO: Beansprout Pediatrics is participating in Aetna EPO Products.  These are available through the Aetna website and healthcare.gov.  Please note, this plan limits hospital services to only Seton facilities.  St David’s is not participating

 

Aetna:  Austin PPO.  Austin HMO.  Austin HMO Open Access Manage Plan & Save Plus, Save & Maximum

POS

 Anthem

 Assurant

 Beech Street

 Benefit Administrative

 Blue Cross Blue Shield: PPO.  HMO Blue.  *Blue Advantage HMO (Health Care exchange plan).

 Boon-Chapman

 Cigna :   Open Access PPO.  Open Access HMO

 GEHA

 Golden Rule

 Great West

 Health First Plans

 Health Partners

 Humana:    Choice Care PPO & HMO

 Meritain

 Multi Plan

 Oxford

 PHCS

Scott & White HMO & PPO

 Seton Physician Health Network SPHN

 StarMark

 The Loomis Co

 UMR

 Unicare

 United Health Care:  PPO. POS. Choice HMO.  *All Compass plans included (Health Care  exchange plans). .

 Web- TPA

  

Beansprout is not "in network" & does not accept the following plans

Humana HMOX:  Beansprout Pediatrics is NOTparticipating in this plan.  Humana HMOX is a closed network.  Since the plan inception in 2015, Beansprout Pediatrics has requested participation.  However, Humana closed the plan to new providers at its inception.  Please note, this plan limits hospital services to only Seton facilities.  St David’s is not participating.  We will notify our patients as soon as we are considered in network with this plan.

 

Aetna Advantage QHP

Cigna – Local Plus

Cigna – Local Plus IN

Cigna – Choice Fund Local Plus

Humana HMO X  *Health Care Exchange Plan  

Medicaid/CHIP/Star Health / Star Plus

Tricare

 

newborns and insurance

Many new parents are unsure how insurance works for their new baby. Most insurance plans will cover the baby automatically for the first 30 days under mom's policy, but not all do. Contact your insurance company customer service department and your HR department about what's required to add the baby to your policy.