Texicare Members Access Mobile Primary and Urgent Care

Benefit Guidance for UrgentCare2go Home and Workplace Visits

When you feel unwell, traveling to a clinic may add more stress to your day. UrgentCare2go™ provides mobile primary and urgent care for eligible patients at home, work, a hotel, or another appropriate location within available Texas service areas.

Texicare members may be able to use their medical benefits for eligible mobile services. Coverage, provider participation, and member costs depend on the exact Texicare plan, network, requested service, and current eligibility.

Which Texicare Plan Do I Have?

Texicare provides several types of health plans for Texas small businesses, including TotalCare, SimplicityCare, and SavingsCare plans. Benefits and member costs vary between plans.

Your insurance card and current benefit documents should identify:

• Texicare plan name

• Medical network

• Member identification number

• Group identification number

• Primary care benefits

• Urgent care benefits

• Deductible and coinsurance

• Out-of-pocket maximum

• Member-services telephone number

• Provider-search information

• Prior-authorization requirements

• Claims-submission instructions

Do not rely on benefit amounts associated with a different Texicare plan. A TotalCare member, SimplicityCare member, and SavingsCare member may have different costs for the same medical service.

An insurance card does not guarantee coverage or payment. Final member responsibility may depend on eligibility, network participation, deductible status, medical necessity, authorization requirements, plan exclusions, and the services provided.

Can Texicare Members Use UrgentCare2go?

Eligible Texicare members may be able to use UrgentCare2go for many routine and non-life-threatening medical concerns.

The mobile medical team may evaluate concerns such as:

• Cold and flu symptoms

• Cough, congestion, or sore throat

• Fever and body aches

• Allergies and sinus concerns

• Ear pain

• Headaches and migraines

• Nausea, vomiting, or diarrhea

• Urinary symptoms

• Minor infections

• Mild allergic reactions

• Rashes and minor skin concerns

• Minor cuts, burns, sprains, and strains

• Medication questions

• Routine primary care concerns

• Certain chronic-condition follow-ups

• Laboratory-result follow-ups

Available services depend on the patient’s location, symptoms, medical needs, provider judgment, and resources required for the visit.

UrgentCare2go does not provide immunizations or children’s annual physical examinations.

Call 911 or visit the nearest emergency room for chest pain, severe breathing difficulty, signs of a stroke, fainting, confusion, uncontrolled bleeding, major trauma, or another potentially life-threatening emergency.

How Do Texicare Networks Work?

Texicare directs members to enter their ZIP code to locate providers connected to their specific network. This means provider participation should be confirmed using the member’s exact plan and location.

Before scheduling a mobile visit:

• Review the network listed on your insurance card

• Search the Texicare provider directory

• Confirm UrgentCare2go’s participation

• Confirm the treating medical professional

• Confirm coverage for the requested service

• Ask whether mobile and clinic-based care use different benefits

• Ask whether the treatment location affects coverage

A provider may participate with one Texicare network without participating with every plan.

How Do I Verify My Mobile-Care Benefits?

Call Texicare at (800) 910-0195 and ask the representative to review your exact plan. Texicare representatives are available Monday through Friday from 8:00 a.m. to 5:00 p.m.

Helpful questions include:

• Does UrgentCare2go participate with my Texicare plan?

• Is the treating medical professional in network?

• Are mobile primary care services covered?

• Are mobile urgent care services covered?

• Are physician house calls covered?

• Which copay applies to my appointment?

• Does my deductible or coinsurance apply?

• Are laboratory tests billed separately?

• Are medications or supplies billed separately?

• Is prior authorization required?

• Is a primary care referral required?

• Will I have a time-of-service responsibility?

• Is reimbursement available if I pay directly?

Write down the representative’s name, the date of the call, and the reference number provided.

UrgentCare2go can collect your insurance information and review available benefits before the appointment. However, Texicare provides the official benefit determination, and final coverage is established after the claim is processed.

Are Mobile Visits Processed as Primary or Urgent Care?

The appointment may be processed under primary care, urgent care, or another medical benefit category based on the reason for the visit and the services provided.

Primary care may include:

• Routine health concerns

• Medication management

• Follow-up visits

• Laboratory reviews

• Monitoring of certain chronic conditions

• Preventive health discussions

Urgent care may include:

• Sudden illnesses

• Minor infections

• Respiratory symptoms

• Urinary concerns

• Stomach symptoms

• Rashes

• Minor injuries

Ask Texicare which benefit category applies before scheduling. The classification can affect the copay, deductible, coinsurance, and final member responsibility.

Is Prior Authorization Required?

Texicare requires prior authorization for certain procedures, treatments, and medications. Requirements depend on the member, plan, diagnosis, and requested service.

Ask whether authorization is required for:

• Mobile medical visits

• Physician house calls

• Certain laboratory tests

• Diagnostic imaging

• Medical procedures

• Specialist referrals

• Certain medications

• Ongoing treatments

• Follow-up services

Prior authorization does not guarantee payment. Current eligibility, medical necessity, network participation, deductible requirements, plan exclusions, and the completed claim can affect how the service is processed.

Providers can check Texicare eligibility, member costs, precertification requirements, and claim status through the provider portal.

Are Referrals Required?

Referral requirements depend on the member’s exact Texicare plan.

Some members may be able to schedule primary and urgent care directly. Other plans may require the member to designate a primary care provider or receive a referral before obtaining certain services.

If your plan requires a primary care provider:

• Confirm the provider currently listed on your plan

• Ask whether a provider change is required

• Complete the change before the appointment when necessary

• Request a reference number

• Ask when the change becomes effective

Specialist care, diagnostic testing, procedures, and follow-up treatment may have separate referral or authorization requirements.

Does Texicare Offer Virtual Care?

Texicare identifies CirrusMD as its virtual-care partner, and its current plan information describes $0 virtual care through CirrusMD. This benefit is separate from determining whether another medical provider participates in your Texicare network.

Members interested in UrgentCare2go should still confirm:

• UrgentCare2go network participation

• Mobile primary care coverage

• Mobile urgent care coverage

• Applicable copay or deductible

• Whether virtual and mobile services use different benefits

Do not assume that coverage for Texicare’s designated virtual-care service automatically applies to other providers or mobile visits.

What Should I Prepare for the Visit?

Before your appointment, prepare:

• Current Texicare insurance card

• Valid photo identification

• Current medication list

• Known medication or food allergies

• Relevant medical records

• Recent laboratory or imaging results

• Referral or authorization documents

• Description of your symptoms

• Date your symptoms began

• Preferred pharmacy information

• Benefit-verification reference number

• Questions for the medical professional

Choose a clean, well-lit area with enough room for the medical team to complete the evaluation.

An adult should remain present throughout the appointment. Pets must be secured in a separate area before the medical assistant arrives.

UrgentCare2go uses a three-hour arrival window and sends a text message when the medical assistant is on the way.

What Should I Expect During the Appointment?

The medical team will review your symptoms, medical history, medications, and allergies. Your vital signs may be checked before the medical professional completes the evaluation.

Depending on your needs, the care plan may include:

• Medication recommendations

• Laboratory testing

• Diagnostic imaging orders

• At-home care instructions

• Follow-up appointments

• Specialist referrals

• A higher level of care when necessary

The medical professional will explain the recommended next step and answer questions about your care.

Can I Request Reimbursement?

Texicare provides a reimbursement form for certain eligible medical expenses that members pay directly. The member must verify benefits and eligibility before requesting reimbursement. Out-of-network services may not be covered except in certain emergency or urgent situations.

Before paying directly, ask Texicare:

• Is reimbursement available for this service?

• Is UrgentCare2go considered in network?

• What documentation is required?

• Is a claim required before reimbursement?

• Does the plan require an itemized receipt?

• Is diagnosis or procedure information required?

• What filing deadline applies?

Reimbursement is not guaranteed. Keep copies of itemized receipts, benefit-verification information, medical records, and any claim documents.

Claims Information for Providers

Claims should be submitted using the information connected to the member’s exact Texicare plan and insurance card.

Providers should verify:

• Electronic payer identification number

• Claims mailing address

• Member eligibility

• Plan and network name

• Mobile-care benefits

• Primary and urgent care benefits

• Provider participation

• Prior-authorization requirements

• Referral requirements

• Timely filing limits

Texicare’s provider resources display payer identifiers, including 07689 and TXCARE, but the correct submission information should be confirmed for the individual member before filing a claim.

After the claim is processed, the member may receive an Explanation of Benefits. This document is not necessarily a bill. It explains how Texicare reviewed the claim, what the plan paid, and what amount may be the member’s responsibility.

Compassionate Medical Care Where You Need It

UrgentCare2go makes it easier for eligible Texicare members to receive medical care without an unnecessary trip to a clinic.

The medical team will listen to your concerns, determine whether mobile care is appropriate, and explain the recommended next step.

Review UrgentCare2go insurance information, check appointment availability, or call (817) 508-8169.

Please have your Texicare insurance card available so your eligibility, benefits, network participation, and expected member costs can be reviewed before the visit.