Texas Children’s Urgent Cares Insurance and Billing

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Billing Information

Payment for medical services can be made by credit card and is due at the time of service. It is the parent or guardian's responsibility to pay any deductible, co-pay or co-insurance required by the insurance provider. As a courtesy, our office will file claims with any of our Texas Children's Pedatrics-contracted insurance plans. Please bring your insurance card to every visit.

For more information about billing and payment practices, please view our financial policy/(En Español).

Insurance plans we accept

Texas Children’s Urgent Care is contracted with the insurance companies listed below. If your child is covered by one of these plans, all charges will be considered “in network.” If your child’s insurance company is not listed, charges may be covered under your “out of network” benefits.

Commercial Insurance Plans

• Aetna - HMO, PPO, POS - effective date is 8/1/22
• BCBS - BlueChoice PPO, POS , EPO
• BCBS - Blue Essentials (formerly HMO Blue of Texas)
• BCBS - BlueCrossBlueShield TX ParPlan
• Cigna-Great West HMO, PPO, POS
• ChoiceCare Network PPO (Humana)
• First Care Health Plans (a Baylor Scott & White Plan)
• First Health PPO
• Galaxy Health Network – Commercial Plan
• Humana - HMO, PPO, POS
• Imagine Health PPO
• Molina Healthcare
• MultiPlan PPO - (Includes Beechstreet)
• PacifiCare (UHC) HMO, PPO, POS
• Private Healthcare System (PHCS) - Savility PPO
• United Healthcare HMO, PPO, POS
• USA Managed Care Organization PPO
• USFHP (US Family Health Plan)
• Scott & White Health Plan

Government Insurance Plans

• Aetna Better Health of Texas - Star-Kids, Medicaid STAR, CHIP
• Ameri-Health Carita - CHIP, Medicaid STAR, STAR Plus*
• Blue Cross and Blue Shield of Texas Medicaid - CHIP, Medicaid STAR, STAR Kids, STAR Plus
• Community First Health Plans - Star-Kids, Medicaid STAR, CHIP
• Community Health Choice (CHC) MarketPlace plan - Kelsey Care only
• Community Health Choice (CHC) - STAR, CHIP
• First Care Health Plans (a Baylor Scott & White Plan)
• Medicaid - Children with Special Health Care Needs (CSHCN)
• Medicaid (TMHP) - Traditional
• Molina Healthcare - Star-Kids, Medicaid STAR, CHIP, Star-Plus, CHIP Perinatal, Marketplace – Out of Network
• Right Care Health Plan (a Baylor Scott & White Plan)
• Superior HealthPlan STAR Health - Foster Care
• Superior HealthPlan STAR, CHIP, & STAR Kids
• Texas Children's Health Plan (TCHP) - STAR, STAR Kids, CHIP
• TRICARE East HMO, PPO - Humana Military
• United Healthcare Community Plan - STAR, STAR Plus, STAR Kids, CHIP

* Not available for Austin locations

Self-pay rates

If your child is not covered by insurance, Texas Children’s Urgent Care offers discounted self-pay rates at the time of service. Self-pay rates include all charges related to the diagnosis and treatment of your child as well as any lab tests or procedures performed in the clinic. They do not include any charges for lab tests performed outside of the clinic. Our staff will notify you before any outside lab work is sent.

There are 3 self-pay rates based on the complexity of the visit.

Tier 1: (Low Complexity)

Office visit and maximum of 3 procedures listed below (more than 3 procedures in Tier 1 will be a Tier 2 visit)

• Point of care testing (example: strep, flu, UPT, urine, blood glucose, etc.)
• Non-blood work Quest labs (you may receive a separate lab bill)
• In-clinic rectal or oral over-the-counter medications

Tier 2: (Medium Complexity)

Office visit and maximum of 3 procedures listed below (more than 3 procedures in Tier 2 will be a Tier 3 visit)

• Urine catheterization
• Ear irrigation, Elephant Ear Wash system
• Woods lamp exam
• Crutches with patient education
• In-clinic oral/topical prescriptions

Tier 3: (High Complexity)

Office visit and procedures listed below

• Breathing inhalation treatment
• Deep suction
• Cervical spine stabilization
• Blood work (may receive separate lab bill)
• X-ray
• Splinting (pre-formed/Ortho-Glass splinting system)
• Intravenous medication/rehydration
• Injectable medications
• Laceration repair (sutures/staples/skin adhesive)
• Foreign body removal
• Incision and drainage, nail cauterization
• Wound/burn care

If your child is covered by insurance, please bring your insurance card with you to simplify registration. We will submit charges directly to your insurance company. Your urgent care copay will be collected at the time of service. If your plan does not have an urgent care copay, we will collect the specialist copay listed on your card at the time of service.

About 30 days after your visit, you should receive a notice from your insurance company summarizing the charges and payment for service. If your insurance company has covered the full amount, it will send payment directly to us. If the insurance company has applied some of the charges to your deductible, we will send you a bill for the amount still owed.

Each insurance plan is a contract between you and your insurance company, and each plan is different. If you have questions about your plan benefits and which charges will be applied to your deductible, please contact your insurance company directly.