Insurance and Billing Accepted Insurance Plans
If Texas Children's is an out-of-network provider, health plans may still approve coverage for treatment with an out-of-network authorization. For non-emergent services, both an out-of-network authorization and single case agreement must be in place before services are provided.
Emergency services at a Texas Children’s Hospital emergency department does not require any prior authorization or pre-treatment agreement.
Patients with questions regarding the out-of-network process should contact their health insurance plan.
Health Insurance Plan information applies to the following locations:
Texas Children’s Hospital Locations
- Texas Children’s Hospital
- Texas Children’s Pavilion for Women
- Texas Children's Hospital – North Austin
- Texas Children’s Hospital – West Campus
- Texas Children’s Hospital – The Woodlands
Texas Children's Specialty Care Locations
- Texas Children's Specialty Care - Austin
- Texas Children's Specialty Care - Bellaire
- Texas Children's Specialty Care - Cy-Fair
- Texas Children's Specialty Care - Clear Lake
- Texas Children's Specialty Care - Eagle Springs
- Texas Children's Specialty Care - Kingwood Glen
- Texas Children's Specialty Care - Sugar Land
- Texas Children's Specialty Care - Upper Kirby
- Texas Children's Pavilion for Women – Pearland
Community Maternal Fetal Medicine Clinic Locations
- Community Maternal Fetal Medicine Clinic - The Woodlands
- Community Maternal Fetal Medicine Clinic - Northwest Houston
- Community Maternal Fetal Medicine Clinic - West Houston
- Community Maternal Fetal Medicine Clinic - Sugar Land
- Community Maternal Fetal Medicine Clinic - Baytown
- Community Maternal Fetal Medicine Clinic – The Methodist Hospital
Below is a list of payers who are contracted with Texas Children’s Hospital, Texas Children’s Physician Service Organization, and Texas Children’s Anesthesiology. Please confirm Texas Children’s participation with your health plan as some benefit plans utilize narrow networks which may exclude Texas Children’s.
Facility-based physicians bill and collect independently for their services, and may not participate in the same insurance plans as Texas Children’s Hospital. You may receive a bill from a facility-based physician for the amount unpaid by your insurance plan.
Please confirm network participation directly with your health plan. Some Employer Group Plans may exclude Texas Children’s Hospital from their network.
Aetna
- Aetna National Medical Excellence Unite (NME)
- EPO
- HMO
- POS
- PPO
Aetna Better Health of Texas
- Star-Kids
- Medicaid STAR
- CHIP
Alianza Mounte Sanai
AmeriHealth Caritas Louisiana
- Medicaid (Healthy Louisiana)
Amerigroup - OUT OF NETWORK
AXA Assistance USA
Banco CentroAmericano de Integracion Economic
Blue Cross and Blue Shield of Texas
- Blue Distinctions Centers for Transplants
- HMO Blue/Blue Essentials
- POS
- PPO
- Traditional
- Excluded: Health Insurance Marketplace plans
Blue Cross and Blue Shield of Texas
- Blue Distinctions Centers for Transplants
- HMO Blue/Blue Essentials
- POS
- PPO
- Traditional
- Excluded: Health Insurance Marketplace plans
Blue Cross and Blue Shield of Texas Medicaid
- CHIP
- Medicaid STAR
- STAR Kids
- STAR Plus
Cigna
- CIGNA LIFESOURCE including Exchange Local Plus
- HARRIS COUNTY
- HMO/POS
- LOCAL PLUS
- PPO
- SURE FIT
- Excluded: Health Insurance Marketplace plans
Community First Health Plans
- Star-Kids
- Medicaid STAR
- CHIP
Community Health Choice
- CHIP
- CHIP Perinate
- Medicaid Star
- Excluded: Health Insurance Marketplace – Community Network
Entrust
Evolutions Healthcare Systems
- PPO
First Care Health Plans
- CHIP
- HMO
- PPO
- STAR
First Health (seeing Coventry members)
- PPO
Galaxy Health Network
- PPO
Generali Medico Compana de Seguros, S.A.
Green Tree Administrators
- PPO
HealthSmart Preferred Care, Inc.
- Accel/AP-3 Product
- HealthSmart Payors Organization
- PPO
Humana
- ChoiceCare PPO
- Humana National Transplant Network
- HMO
- PPO
- Excluded: Health Insurance Marketplace plans
Imagine Health PPO
Independent Medical System, LTD
- PPO
INTERLINK Health Services
- Transplant
Kelsey Seybold Medical Group
- Medicare Advantage
LifeTrac
- Transplant
MedCorp Southwest
Medicus International
MedSave USA
Molina Healthcare
- Star-Kids
- Medicaid STAR
- CHIP
- Star-Plus
- CHIP Perinatal
Multiplan
- PPO
National Health Care Solutions
Optum Healthcare (formerly United Resource Network)
Point Comfort Underwriters (ORR Program)
Private Healthcare Systems, Inc. (PHCS)
- PPO
Provider Networks of America
Quality Health Management
RightCare from Scott & White Health Plan
- Medicaid STAR
Scott & White Health Plan
Seguros Atlas
Seguros Inbursa, S.A.
Superior Health Plan
- CHIP
- Medicaid STAR
- STAR Health (Foster Care)
- STAR Kids
Texas Children's Health Plans
- CHIP
- Medicaid STAR
- STAR Kids
Texas Medicaid
- Star-Kids
- Medicaid STAR
- CHIP
- CHIP Perinatal (applies to hospital only)
TriCare (Humana Military)
Uniformed Services Family Health Plan (USFHP)
United Healthcare
- HMO
- POS
- PPO
- Excluded: Health Insurance Marketplace plans
United Healthcare Community
- CHIP
- Medicaid STAR
- STAR Kids
- STAR Plus
Market place plans - OUT OF NETWORK
(individual plans through www.Healthcare.gov)
- Molina Healthcare
Out of Network Authorization is require by all market place plans prior to seeking care at Texas Children’s.
Transplant centers of excellence
The Transplant Program at Texas Children’s Hospital is dedicated to providing the highest quality of care to children needing heart, lung, liver or kidney transplantation through evidenced-based practices, research and education.
| Transplant Network | Heart | Kidney | Liver | Lung | BMT | CHD | ACHD | VAD | CAR-T |
|---|---|---|---|---|---|---|---|---|---|
| Aetna Institute of Excellence | X | X | X | X | X | X | N/A | X | N/A |
| Blue Distinction Centers for Transplants | X | N/A | X | N/A | X | N/A | N/A | N/A | N/A |
| Cigna LifeSOURCE Transplant Network | X | X | X | X | X | N/A | N/A | X | X |
| Humana National Transplant Network | X | X | X | X | X | N/A | N/A | N/A | N/A |
| INTERLINK Medical Excellence Programs | X | X | X | X | X | X | N/A | X | N/A |
| Emerging Therapy Solutions | X | X | X | X | X | X | N/A | X | X |
| Optum Centers of Excellence | X | X | X | X | X | X | X | N/A | N/A |
CHD = Congenital Heart Disease
VAD = Ventricular Assist Device