GENERAL INFORMATION
Texas Native Health’s services are rooted in the community and are designed to provide culturally competent care. Choosing to use your insurance at our clinic not only benefits you individually, but also contributes to supporting Texas Native Health overall. Texas Native Health does not charge patients for any services whether insured or non-insured.
HOW THE USE OF INSURANCE AT TEXAS NATIVE HEALTH BENEFITS YOU
- Texas Native Health does not charge patients for their visits. This means that when patients use their insurance at our clinic, they are not incurring any out-of-pocket expenses for the services received but will receive credit for the visit with their insurance provider.
- When you use your insurance at TNH, the cost of services provided at our clinic contributes towards meeting your annual deductible. See below for explanation of Deductibles.
- Visits to Texas Native Health help patients reach their “Max out of pocket” expenses. See below for explanation of Maximum Out-of-Pocket (Max OOP).
HOW YOUR USE OF INSURANCE SUPPORTS TEXAS NATIVE HEALTH
- Receiving reimbursement from insurance providers helps our organization to maintain financial sustainability. The funds obtained from insurance claims can be used to cover operating costs, purchase necessary medical equipment, and invest in infrastructure improvements, as well as coverage for the direct care of community members who do not have private insurance.
- With a reliable source of revenue from insurance, Texas Native Health may have the means to expand and enhance the range of services offered to their community. This could include the addition of specialized medical services, the hiring of more healthcare professionals, or the introduction of preventive health programs.
- Insurance reimbursements can be used to improve and update the clinic’s infrastructure, ensuring that it meets current and future healthcare standards. This may involve upgrading medical facilities, investing in advanced technology, or maintaining a clean and welcoming environment for patients.
GENERAL HEALTH INSURANCE INFORMATION
What are Premiums?
- Premiums are the amount you pay an insurance company for coverage. Premiums are generally paid monthly.
What are Deductibles?
- The deductible is the amount of money that a policyholder must pay out of pocket for covered healthcare services before their insurance plan starts to contribute. It is a fixed annual amount. Once the deductible is met, the insurance plan begins sharing the costs with the policyholder through copayments or coinsurance.
Example: If a health insurance plan has a $1,000 deductible, the policyholder is responsible for paying the first $1,000 of covered medical expenses in a given year. After meeting the deductible, the insurance plan begins to cover a portion of the costs.
What is a “Max-out-of-Pocket”?
- The maximum out-of-pocket limit is the absolute maximum amount a policyholder is required to pay for covered healthcare services in a specific time period, usually a calendar year. It includes all out-of-pocket costs such as deductibles, copayments, and coinsurance. Once the policyholder reaches this maximum, the insurance plan covers 100% of covered expenses for the remainder of that time period.
Example: If a health insurance plan has a maximum out-of-pocket limit of $5,000, the policyholder will not have to pay more than $5,000 for covered medical expenses in a calendar year. After reaching this limit, the insurance plan covers all additional covered expenses.
What are Co-Pays?
- Co-pays are flat fees you are required to pay for prescriptions or covered services (often listed on the back of your insurance card.
- Co-pays are never charged to patients by Texas Native Health.
Coverage of Medicines
- Each insurer has a formulary (list of medicines) covered by their plan. If a medicine is not on the formulary, it may not be covered, and patients will then go through a process to obtain coverage. The list of covered medicines is divided into tiers that determine how much of a co-pay you may have to pay.
- Texas Native Health has an in-house pharmacy and patients are not charged to obtain their medications here. Not all medications are available at the pharmacy but can be prescribed to outside pharmacies. Medications filled at outside pharmacies must be paid for by the patient’s insurance or by the patient if no insurance is available.
**NOTICE**
Texas Native Health itself is not an insurance provider. Care received from facilities outside of TNH or other tribal facilities is the financial responsibility of patients.