Hidden truths about Co-Pay Health Insurance Plans in Texas

In Texas there are basicially three types of health insurance plans, the health savings account high deductibles plans, the P.P.O. doctor co-pay plans and the limited benefit plans. Today I will just talk about the PPO doctor co-pay plans and how so many Texas families find confusion or become dissatisfied after a claim is processed after a doctor visit.

OK, lets set this up. You take your young son to the doctor because of an apparant cold he has. While at the visit the doctor decides to run a few test to get a better idea of what he is dealing with. Lets say some blood test and a throat culture are done. He determines all is fine your son just has a cold, gives you a few sample drugs and your on your way with only the twenty dollar co-pay. It’s all over, right? Well, unfortunately WRONG!!

Two weeks later you open the mail and you have received this strange bill from the doctors office for lets say three hundred dollars, this bill says something about all the testing that was preformed the day of your sons visit as not covered by your insurance company. Whats the first thing most Texas families do? Call the agent or Texas health insurance company asking why was it not covered. I have taken countless of calls related to this very issue.

Most times the lab work preformed on your son was not denied for coverage, is was applied to your yearly deductible. This is so very frustrating to both the agent and you the client. For years most individual health insurance companies in Texas would have a co-pay for the doctor visit ONLY and all other charges applied to a deductible that was so extremely high the consumer would never meet it. Almost 100% of policies operated in this fashion for years up until just a year or so ago. Now I am finding more and more Texas health insurance policies allowing lab and x-rays to be covered in the co-pay eliminating the hassle and stress of figuring out a claim.

In my view it all started with Aetna, about three years ago when they introduced their individual health insurance policy in Texas they paid lab and x-rays within the small co-pay, provided the charges were incurred at the time of the doctor visit and done in his office. This health insurance policy eliminated clients calling and discussing claim problems with their agent instantly. It was amazing. But most all the other Texas health insurance policies all still applied charges outside the normal doctor visit consultation to the base deductible.

Moving the clock forward to today I find that more and more Texas health insurance companies are starting to pay lab charges within the co-pay and the Texas health insurance consumer is the winner. Texas health insurance companies like Unicare, Golden Rule/Unitedhealth Care, and Humana have to a certain degree  all followed Aetna on this practice and more and more of my business seems to be moving toward these companies. Unicare made the biggest change by also allowing more preventive coverage for children under eighteen and a simple co-pay for emergency room treatment. They made drastic changes with their benefit configuring and just comparing apples to apples Unicare offers the best policy on paper than any company in the Texas health insurance market.

When you decide it’s time to start looking at a new Texas health insurance plan keep in mind the pitfalls of the doctor co-pay and get assurances from your Texas health insurance agent or broker than the new plan you are getting is what’s called an all inclusive co-pay so you don’t have any hidden surprises awaiting you in the mail. Your wallet will thank you!