ACCEPTED INSURANCE PLANS
Important It is the patient's responsibility to know the stipulations of their insurance policy, including referral & fee policies. Lake Pointe Orthopaedics is responsible for educating the patient of changes in their benefits or policy. We recommend that the patient verify coverage/benefits before their appointment, as well as insure proper referrals have been requested and sent to our office before their scheduled appointment.
- Accountable (PPO)
- Aetna (EPO)
- Aetna (HMO)
- Aetna (MC)
- Aetna (PPO)
- Aetna (POS)
- American Medical Security (PHCS)
- Anthem (HMO)
- Anthem (POS)
- BCBS (HMO Blue)
- BCBS Blue Choice (PPO)
- BCBS Blue Choice Plus (POS)
- BCBS Federal Select (PPO)
- BCBS Health Select (POS)
- Beech Street (PPO)
- Beech Street Workers Comp.
- Blue Advantage (HMO)
- Blue High Performance Network
- Blue Premier (HMO)
- Care Improvement Plus
- Corvel Workers Comp
- Centra Select
- Champ VA
- CHIP (Medicaid)
- Choice One (PPO)
- Choice Care PPO
- Cigna (PPO)
- Cigna (True Access) (EPO)
- Concert Health (PHCS)
- Consolidated Health Plans (PHCS)
- EHN PPO
- First Health (PPO)
- First Health (WC)
- First Health (Texas Instruments)
- PHCS
- Galaxy HealthCare PPO
- Galaxy Medical Savings Plan
- Great West HMO
- Great West Open Access
- Great West POS
- Health E Innovations Workers Comp.
- Healthcare Partners of E Tx
- IMS PPO
- Interplan Health Group
- HealthSmart
- HMO Blue Texas (Formerly NYLCare HMO)
- HealthSmart
- HMO Blue Texas
- Humana, Inc **Non-PHCS** (HMO)
- Humana, Inc **Non-PHCS** (POS)
- Humana, Inc **Non-PHCS** (PPO)
- Humana Medicare Advantage HMO PPO
- MyBlue Health
- Integrated Health Plans
- Intetrated Medical Systems (EPO)
- Managed Care, Inc. (PPO)
- Managed HealthCare (PPO)
- Medicaid (excludes Evercare)
- Medical Control (PPO)
- Medicare
- Multiplan PPO
- Mutual of Omaha (HMO)
- Mutual of Omaha (POS)
- Mutual of Omaha (PPO)
- Net One (PPO)
- North Texas HealthCare Network (EPO)
- North Texas HealthCare Network Gatekeeper (EPO)
- NPPN
- North Texas HealthCare Network (HMO)
- North Texas HealthCare Network (POS)
- North Texas HealthCare Network (PPO)
- Pacificare (HMO)
- Pacificare
- PHCS(POS)
- PHCS (PPO)
- PHCS HAP)
- PHN
- Preferred Plan of Texas (PPO)
- Principal (PPO)
- Provider Networks of America (PPO)
- Secure Horizons
- Senior Health Plan
- Southwestern Health Plans
- STAR (Medicaid)
- STAR Kids (Medicaid)
- Summit Administrative Services
- The Principal (PPO)
- TML (PPO)
- Triwest
- United HealthCare (EPO)
- United HealthCare (HMO)
- United HealthCare (Open Access) (HMO)
- United HealthCare (Choice) (HMO)
- United HealthCare (Choice Plus) (HMO)
- United HealthCare (Plus) (HMO)
- United HealthCare (POS)
- United HealthCare (PPO)
- USA HealthCare (PPO)
- USC (EPO)
- USC (PPO)
- VHA Southwest (PPO)
- Texas Health Choice (HMO)
- Texas Health Choice (PPO)
- Texas First Medicare
- Texas True Choice PPO
- UHC HMO select
- UHC Choice Options
- USA MCO
- WellCare Medicare HMO
WORKERS’ COMPENSATION HEALTH CARE NETWORKS
- Aetna
- Argus Provider Network
- Beech Street
- Bunch and Association, Inc. TX HCN
- Cigna Workers HCN
- CMI Barron Risk Management
- Concentra Health Care Network
- Coventry
- Corvel HealthcareCorp
- First Health/AIG TX HCN
- First Health TX HCN
- Focus HCN
- Forte Inc./First Health
- Hartford Workers Comp HCN
- Health E Innovations
- International Rehab Associates/Intracorp
INSURANCE TERMINOLOGY AND DEFINITIONS
EXCLUSIVE PROVIDER ORGANIZATION (EPO)
Form of managed care in which participants are reimbursed only for care received from affiliated providers.
HEALTH MAINTENANCE ORGANIZATION (HMO)
A plan that offers a variety of services including physical exams, education, and preventative medicine programs, in exchange for a fixed-monthly premium. An HMO may be an independent company, or it may be sponsored by an employer, insurance company, hospital, union, or government agency. Members either select or are assigned a primary care physician who is responsible for all referrals in providing adequate patient care.
INDEMNITY INSURANCE
Insurance policies through which benefits are paid in a predetermined amount for a covered loss. Usually, the insured person receives services and submits a claim to the insurer, and providers are paid fees for the services rendered.
INDEPENDENT PRACTICE ASSOCIATION (IPA)
Plans that contract with individual practitioners who work at their own offices. Unlike salaried HMO staff, IPA physicians are allowed to treat patients from other health care plans, along with their own fee-for-service patients.
MAJOR MEDICAL EXPENSE INSURANCE
A form of health insurance that provides benefits for most types of medical expenses (surgical, hospital) up to a high maximum benefit. Such contracts may contain internal limits and usually are subject to deductibles and co-insurance costs.
MANAGED CARE (MC)
Systems that integrate the financing and delivery of appropriate health care services by means of arrangements with selected providers to furnish a comprehensive set of health-care services to members.
POINT OF SERVICE (POS)
Plans tend to be more flexible than HMOs, but also require you to select a Primary Care Physician (PCP). Depending on insurance stipulations, the patient may choose to visit a doctor outside the network and still receive coverage — but the amount covered will be substantially less than if using a physician within the network. Some plans may require the patient to pay up-front and submit the claim for reimbursement.
PREFERRED PROVIDER ORGANIZATION (PPO)
A network of physicians and hospitals that provides an insurance company or employer with discounts for its services. Consumers covered by a PPO are allowed to use providers outside the PPO network, including specialists whenever they choose, for an additional expense.
PREPAID GROUP PRACTICE INSURANCE
A plan under which specific health services are provided by participating physicians to an enrolled group of persons, with a fixed periodic payment made in advance by or on behalf of each person or family.
SPECIFIC DISEASE INSURANCE
Insurance providing a benefit, subject to a maximum amount, for expenses incurred in connection with the treatment of specified diseases, such as cancer. These policies are designed to supplement major medical policies.