Frequently Asked Questions

Below are links to other Web sites that will provide you with additional information about important health concerns. Please note: if you click on any of the links below, you will leave this Web site.

Q: I've heard I'll need a Personal Care Physician (PCP). What does that mean?

As an HMO member, you are required to select an affiliated Personal Care Physician (PCP) to help manage your healthcare. Your PCP will collaborate with you, your pharmacist and various medical specialists and professionals to help manage your medical care.

Click here to visit our Provider Search tool to locate your physician.

To make PCP changes, call your customer service line toll-free at: 1-866-230-2513 8:00 a.m. to 8:00 p.m. in your local time zone (TTY users call 1-800-958-2692) every day.

Q: How can I find out if my physician is affiliated with my health plan?

There is a good chance your physician is already with us. To make sure your physician is health plan affiliated, click here to visit our Provider Search tool to locate your physician.

To make PCP changes, call your customer service line toll-free at: 1-866-230-2513 8:00 a.m. to 8:00 p.m. in your local time zone (TTY users call 1-800-958-2692) every day.

Q: How do I see a specialist?

When specialty services are medically necessary, your PCP will direct you to a specialist (Routine OB/GYN care does not require PCP direction).

Q: What about emergency services?

Your plan includes coverage for emergency services. You are covered around town and around the country. Simply go to the nearest Emergency Room or call 911 for assistance.

If you are admitted to the hospital after an emergency, you'll need to contact us at the number on your ID card or contact your Primary Care Physician (PCP).

Q: Can I continue to see my original physicians?

With most HMOs, including TexanPlus^® HMO, you can only go to doctors, specialists, or hospitals in the plan’s network except in an emergency

Q: I am a Member but have not received approval for medical services. What should I do?

All questions regarding approval for services should be referred back to the ordering physician.

Q: What is an EOB?

If you've visited your doctor or received some type of medical care, you have probably received an Explanation of Benefits (EOB). This statement is from your insurer about health services you’ve received. This statement providers complete information about the health services you’ve received, payments, and any responsibility you have for payment. It is important to remember that the EOB is not a bill. This information is provided for your convenience. If you have question about how much you owe your provider, you should contact your Customer Service department.

Q: What if my prescription medicine is not on the formulary?

If your specific medicine is not on our formulary, there may be a similar, high-quality medicine available that offers the same benefits. For example, if you’re taking a cholesterol-lowering medicine, there might be a suitable alternative on our formulary. We’ll work with you and your doctor to find a covered medicine that best suits your condition.

Q: Does TexanPlus^® have materials that are in Spanish?

Yes, TexanPlus offers materials in Spanish and are available upon request.

You may request Spanish materials by calling 1-866-731-9589 8:00 a.m. to 8:00 p.m. in your local time zone (TTY users call 1-800-777-9083) every day. A TexanPlus representative will be happy to help you.