How to Use Your Medical Plan


Every doctor’s office visit or medical treatment presents you with choices and responsibilities. Texas Health encourages you to be a careful health care consumer. By being informed, asking questions, and making wise decisions regarding your medical care and treatment, you take charge of your health.

Know Before You Go: Tips for Holding Down Your Medical Costs

  • For the Texas Health Aetna Select Plan 1000: Feeling sick and think you might need a prescription? Have a bad cut and aren’t sure if you need stitches? The Texas Health Aetna ER Doc app can connect you with doctors to help answer your questions.
  • For UHC plans: If you have a minor illness, such as a rash, bladder infection or bronchitis, you’ll save money using Virtual Visits. There is no copay, so there’s no charge to you when you visit with a doctor using Doctor On Demand.
  • For all plans: Use generic or mail-order prescription drugs whenever possible. Getting 90-day supplies saves you money on medications you take regularly. You can get a 90-day supply of maintenance medications filled via Caremark’s mail order, at the Texas Health Dallas, Texas Health Plano, Arlington Cancer Center, and Texas Health Resources Infusion Pharmacy or at your local CVS or Target pharmacy.
  • For all plans: Anytime your doctor requests additional procedures or services outside of your doctor’s office, it is highly recommended that you call the claims administrator prior to your date of service to verify the provider is covered under your plan. Most of the time, your doctor’s office doesn’t know which ones are covered under the Total Health plan. Some procedures and surgeries require prior authorization. You can contact your plan administrator to obtain the full list.

Hospital-based Physicians

When you go to a hospital for a procedure (such as surgery or childbirth), you may receive services from hospital-based physicians that you are not aware you have received. For example, if you have an MRI, you typically will not meet the radiologist who interprets the results.

Under most employer-sponsored medical plans, charges are often considered out-of-network for services provided by hospital-based physicians, including radiologists, anesthesiologists, pathologists and emergency physicians.

  • Under the Texas Health Aetna Select Plan 1000, always check doctors and facilities to make sure they are in-network.
  • Under all medical plans, when you use an in-network hospital, Texas Health saves you money by covering hospital-based physician services as in-network. Because most plans do not offer this same advantage, these claims are often processed incorrectly. When you receive your explanation of benefits, you should carefully check your hospital charges to be sure you are not being charged out-of-network rates for these services. If you believe your bill is inaccurate, call your plan administrator and ask for a review of the claim.