Insurance Guide


 

Jacinto Medical Group accepts most major insurance plans (HMOs, PPOs and Medicare). If Jacinto Medical Group is contracted with your current health plan, we will bill your insurance on your behalf. Your plan may require co-payments and deductibles that should be paid when you check in for service. We must have your current and accurate information to submit claims to your insurance company. Please remember to always bring your insurance card and a valid government picture ID. We will verify your insurance at check-in prior to seeing the physician.

Benefits vary from plan to plan. Some of the procedures or tests may not be covered by your insurance. Please contact your insurance company for benefit specific questions including coverage, participation, referral information, restrictions, deductible status, and co-pay requirements.

 

Types of Insurance

 

* HMO:

An HMO is a Health Maintenance Organization. When you join an HMO, you will be asked to choose a primary care physician (PCP). Your PCP will take care of your routine health care needs and coordinate any necessary specialty care. Before you can see a specialist, your PCP will request an authorization for a specialty referral based on your health plan’s guidelines.

If you are covered by one of our contracted HMOs, Jacinto Medical Group will conveniently take care of most paperwork, so you do not have to complete claim forms. HMOs are designed to manage the costs of medical care, which means members enjoy lower out-of-pocket expenses compared to other types of medical insurance. Visits to the doctor’s office, hospital charges and many other medical care expenses are often covered at 100% after a small co-payment. Generally, preventive care, prescription drugs, routine physicals, lab tests, vision exams, well-baby care, and maternity visits are covered. HMO plans do not typically require you to pay an annual deductible before services are covered and usually have no lifetime maximums.

 

* PPO:

A PPO is a Preferred Provider Organization. When you join a PPO, you will have a choice of providers to seek care from within the PPO network. You will have a deductible and/or co-pay if you go to a provider within the network.

A PPO negotiates arrangements with a network of doctors, hospitals, and other providers who accept lower fees from the insurer for their services. If you choose to go to a physician or hospital outside your PPO network, you will have much higher out-of-pocket expenses.

If you are covered by one of our contracted PPOs, Jacinto Medical Group will bill your carrier for services rendered, so you do not have to complete claim forms.

 

* POS:

A Point-of-Service plan, or POS plan, is a type of managed care health insurance system. It combines characteristics of both the HMO and the PPO. Members of a POS plan do not make a choice about which system to use until the point at which the service is being used.

 

* Medicare:

Medicare Part B is the medical insurance portion of Medicare, which covers physician services, outpatient hospital care, and many other services typically covered under health insurance plans. Part B is financed through monthly premiums paid by enrolls and by contributions from the federal government.

If you are covered by Medicare Part B, Jacinto Medical Group will bill Medicare for services rendered, so you do not have to complete claim forms.

Jacinto Medical Group also accepts many Medicare replacement plans that cover the costs of many services not covered by Medicare part B.

Seniors on Medicare parts B are able to use their insurance at Jacinto Medical Group. Jacinto also accepts many Medicare plans, including Medicare Advantage plans, Medicare PPOs, and supplemental plans.

 

MEDICARE ADVANTAGE PLANS ACCEPTED AT JACINTO MEDICAL GROUP:

The Medicare Advantage plans accepted at Jacinto Medical Group have $0 monthly premiums. Medicare Advantage plans have the lowest out-of-pocket costs and the most benefits when compared to original Medicare and supplemental plans. Plans also include prescription coverage, preventive care, and less paperwork.

Medicare Advantage Plans

  • AARP Medicare Complete
  • Aetna Medicare Advantage
  • Aetna Medicare Replacement
  • Care Improvement Plus
  • Humana Choice Care PPO
  • United Healthcare Dual Complete
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