HOW TO USE YOUR MEDICAL PLAN
How to Decide Where to Get Care
Physical Well-being
Virtual Care Services |
Primary Care Provider |
Urgent Care |
DispatchHealth |
Emergency Room |
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| Cost | Free | $ | $$ | $$ | $$$ |
|
Go Here When |
You have a minor, non-emergency health issue. |
You have a non-life-threatening condition(s) or need preventive care |
You know your health concern is NOT life- threatening but you need care quickly and your doctor isn’t available |
You know your health concern is NOT life- threatening but you need care quickly and your doctor isn’t available |
You suspect you have a life-threatening condition |
|
Best Part of Going Here |
No driving, no crowded waiting rooms and 24/7 availability and you can get a prescription if needed |
Your Primary Care Provider knows your medical history; in-person examination and reasonable cost |
No appointment needed and typically shorter waiting times than the ER. |
Urgent Care in the comfort of your own home! |
Necessary for life-threatening conditions; 24/7/365 availability |
|
Reasons to Go |
Minor, non-emergency health issues such as:
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Non-life-threatening conditions or preventive care:
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Non-life-threatening health issues such as:
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Non-life-threatening health issues such as:
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Potentially life-threatening health issues such as:
|
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Good to Know |
The medical plan you are enrolled in has specific apps to use for Virtual Care Services. Employees enrolled in UnitedHealthcare should use Doctor on Demand, AmWell or Teledoc. Employees enrolled in Quantum should use MDLive. |
Make sure to choose an in-network doctor to keep your costs low. If your PCP offers a visit virtually, normal costs will apply. This is different from the virtual care services described in the column to the left |
Many urgent care centers offer imaging, X-rays and lab services |
You must be in an eligible zip code to use this service. Learn more here. |
If your condition is NOT life threatening, you should visit urgent care, your doctor’s office or a walk-in clinic. Otherwise, your cost for using the Emergency Room for a non-life-threatening health issue can be very expensive. |
Mental Well-being
THR EAP |
Headspace |
Behavioral Health Visits |
Medical Plan
|
|
| Cost | FREE | FREE | $ | Varies |
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What You Get |
You can receive up to eight in-person, telephonic, or web-video EAP counseling sessions per issue per year. THR EAP counselors are available to assess your concerns, provide guidance, and develop an action plan to help resolve personal issues. Services are available 24/7 to help you with:
Get more information here. |
Headspace is a mindfulness-based program that helps you take care of you – mind, body and spirit. Through the Headspace app, you can get help with sleep, mindfulness, stress and more. Benefits-eligible employees can get Premium access to Headspace. Get more information here. |
In person or video-based visit with a behavioral or mental health provider |
If you’re enrolled in Unitedhealthcare coverage, you have access to convenient on-demand help with stress, anxiety and more right from your fingertips through the Self Care and Talkspace platforms. |
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Good to Know |
THR EAP services are available to members of your household at no cost. The EAP also offers Work-Life services (legal and financial resources, concierge services, etc.), Self-Care Check-Ins for employees and an online portal called My Life Expert with resources that can be accessed at any time. |
You can invite up to four other people (non-benefits eligible co-workers, friends, family, neighbors) to participate at no cost. |
To locate a provider, login to your member website. If you need assistance locating a provider, contact the vendor for help. UHC: MyUHC.com, 1-877-698-4754 prompt 2, press 2 Quantum: MyQHResource.com, 1-877-698-4754, prompt 2, press 1 |
Have your UHC ID card ready when registering. |
Check out other well-being resources here.
Tips to Keep Your Costs Down
- Take advantage of Be Healthy. The best way to lower your medical costs is to take great care of yourself. Whether you want to improve your diet, lose weight, become more active, or manage a chronic condition, there’s a Be Healthy program that can help.
- Choose in-network doctors and facilities. Under all medical options only in-network doctors and facilities are covered and all in-patient services will cost you the least at a Preferred Hospital.
- Getting Lab Work: if your doctor requires you to get lab work done, the labs that are in network are Lab Corp and Quest Labs. Getting lab work done elsewhere will mean higher costs for you.
- NOTE: For any plan option, if you choose to use the Lab option to get your Wellness Credit Screening, you will go to Quest Lab ONLY. Find out more about that here.
- Know before you go. Anytime your doctor requests additional procedures or services outside of your doctor’s office, call your medical carrier before you get the service to verify how much the plan will pay. Most of the time, your doctor’s office doesn’t know which services are covered and at what percentage under your plan.
- Check if prior authorization is needed. Some procedures and surgeries require prior authorization, which means your carrier has to approve coverage before you get the service. Check with your medical carrier before you schedule any procedure. UHC: MyUHC.com, 1-877-698-4754 prompt 2, press 2 or Quantum: MyQHResource.com, 1-877-698-4754, prompt 2 press 1.
- Check your hospital bill. 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. For most patients with insurance, charges are often considered out-of-network for services provided by radiologists, anesthesiologists, pathologists and emergency physicians. Under all Texas Health medical plan options, 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 from your medical carrier, 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 carrier (Quantum or UHC) and ask for a review of the claim.
- 2nd.MD provides second opinion services for musculoskeletal, cardiac, GI and women’s health diagnoses are available, free of charge for those enrolled in UnitedHealthcare coverage. These services provide you with a second opinion of your diagnosis from a board-certified medical expert.