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Know your options
How much you’ll spend at the doctor depends on what type of doctor you see. Most plans will cover a phone call with a nurse, an online doctor visit, or visits to a doctor’s office, an urgent care clinic, or a hospital emergency room. Nurse lines and online visits are usually cheapest (and often free). Emergency rooms are the most expensive.
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Ask if the doctor is in your plan’s network
Most health plans have a network of doctors, specialists, and other providers. You’ll pay more if you get care outside the network. Ask your health plan if the doctor, facility, or hospital you want to visit is in your network. If you go to a doctor outside your network, ask the doctor about the cost. Some might be willing to negotiate lower prices with you.
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Ask how to save money on prescriptions
Most plans have a list of drugs that they will pay for. The list also shows how much you’ll have to pay. If the drug is too expensive, ask your doctor if there’s a generic version. If you choose the brand-name drug, there may be coupons or discounts that can save you money. Ask your pharmacist where you can find coupons.
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Ask questions if you get a bill
If the visit was covered by insurance, don't pay more than the explanation of benefits from your health plan says you may owe. If the bill was for more than you were expecting, ask the doctor or facility for an itemized bill. Look for errors or duplicate charges. Call your health plan if you have questions. You can also ask the doctor for a discount or an interest-free payment plan.
Note: Texans with state-regulated plans and people with coverage through the state employee or teacher retirement systems are protected from surprise medical bills. Learn more about the protections.
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Ask TDI for help
Call our Help Line at 800-252-3439. We can help resolve complaints with health plans that we regulate and explain your options for other types of plans. More information about health insurance complaints.
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