Texicare Members Access Virtual Primary and Urgent Care

Texas Telehealth Visits with VirtualCare2go Insurance Benefits

When you or a family member feels unwell, leaving home may feel uncomfortable or inconvenient. VirtualCare2go™ provides virtual primary and urgent care visits for eligible patients who are physically located in Texas during their appointments.

Texicare members may be able to use their medical benefits for a VirtualCare2go appointment. However, coverage, provider participation, member costs, and authorization requirements should be confirmed before scheduling.

What Texicare Medical Plans Are Available?

Texicare currently offers three primary plan structures:

• TotalCare

• SimplicityCare

• SavingsCare

Each plan handles office visits, deductibles, copays, coinsurance, prescriptions, laboratory testing, and other healthcare services differently. Texicare also includes virtual care through CirrusMD as a designated benefit in its plans.

Because CirrusMD is Texicare’s designated virtual care partner, its $0 virtual care benefit may not automatically apply to an appointment with VirtualCare2go. VirtualCare2go may be processed as a separate virtual primary care, urgent care, or telehealth provider.

Before scheduling, ask Texicare whether VirtualCare2go participates in your specific network and what member cost applies.

Can Texicare Members Use VirtualCare2go?

Eligible Texicare members and their covered family members may be able to use VirtualCare2go for many routine and non-emergency medical concerns.

The virtual medical team can evaluate concerns such as:

• Cold and flu symptoms

• Cough, congestion, or sore throat

• Fever and body aches

• Allergies and sinus concerns

• Headaches and migraines

• Nausea, vomiting, or diarrhea

• Urinary symptoms

• Minor infections

• Mild allergic reactions

• Rashes and minor skin concerns

• Medication questions

• Routine primary care concerns

• Certain follow-up appointments

The patient must be physically located in Texas throughout the virtual appointment. Coverage depends on the member’s plan, current eligibility, provider-network participation, medical needs, and the services provided.

Some concerns cannot be safely evaluated through telehealth. The medical professional may recommend an in-person examination, laboratory testing, diagnostic imaging, or emergency care when appropriate.

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

How Do Texicare Plan Types Affect Costs?

Member costs can vary significantly based on the Texicare plan.

TotalCare

TotalCare plans currently include four $0 visits per member annually in several categories, including primary care and urgent care. However, whether a VirtualCare2go visit qualifies for one of these visits depends on network participation, benefit classification, and the member’s exact plan.

SimplicityCare

Texicare currently lists a $25 primary care copay and a $75 urgent care copay under its general SimplicityCare plan information. These amounts may not automatically apply to VirtualCare2go, and the virtual appointment’s classification should be confirmed before scheduling.

SavingsCare

SavingsCare is a high-deductible health plan. Primary and urgent care services may be subject to the deductible and coinsurance. The amount owed for a VirtualCare2go appointment will depend on the plan’s rules, network participation, and the negotiated rate.

These are general plan descriptions and are not guarantees of coverage or cost. Review your insurance card and current plan documents for information specific to your enrollment.

How Do I Verify My Virtual Care Benefits?

Before scheduling, call the member-services number on your Texicare insurance card and ask:

• Does VirtualCare2go participate with my Texicare plan?

• Is the treating medical professional in network?

• Are virtual primary care appointments covered?

• Are virtual urgent care appointments covered?

• Is VirtualCare2go separate from the CirrusMD benefit?

• What copay, deductible, or coinsurance applies?

• Will the visit count toward a limited number of covered appointments?

• Are prescriptions, laboratory tests, or follow-up services billed separately?

• Is prior authorization required?

• Is a primary care referral required?

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

• Are there telehealth or geographic restrictions?

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

VirtualCare2go can collect your insurance information and review available benefits before the appointment. However, Texicare provides the official explanation of benefits, and final coverage is determined when the claim is processed.

How Do I Confirm Network Participation?

Texicare provider networks may vary according to the member’s plan and geographic area. A provider participating in one Texicare network may not necessarily participate in every Texicare plan.

To verify network participation:

• Call the member-services number on your insurance card

• Use Texicare’s online provider-search tool

• Search for VirtualCare2go

• Confirm telehealth participation

• Confirm the treating medical professional’s participation

• Ask whether virtual and in-person services use different benefits

• Verify coverage for the specific service you need

Provide your plan name, member identification number, requested service, and physical location in Texas when asking Texicare to confirm participation.

Is Prior Authorization Required?

Prior authorization requirements depend on the member’s plan and the requested service. A routine virtual appointment may not require advance approval, but testing, imaging, procedures, specialist services, medications, or follow-up treatment could have separate requirements.

Texicare maintains a prior-authorization process for services requiring advance review. Its authorization form also directs providers to verify benefits, eligibility, and network participation.

Before receiving additional services, ask:

• Does this service require prior authorization?

• Who is responsible for submitting the request?

• Has the authorization been approved?

• Is the laboratory or imaging facility in network?

• Is a separate referral required?

• What member cost may apply?

Prior authorization does not guarantee claim payment. Final processing may depend on eligibility, medical necessity, network status, deductible requirements, plan exclusions, and other benefit rules.

Are Referrals Required?

Referral requirements depend on the specific Texicare plan. Some members may be able to schedule a virtual appointment directly, while others may need to select a primary care provider or obtain a referral before receiving certain services.

If a VirtualCare2go medical professional recommends specialist care, diagnostic testing, or another service, contact Texicare before scheduling. Ask whether a referral, prior authorization, or specific in-network facility is required.

What Should I Prepare for My Virtual Visit?

Before the appointment, prepare:

• Your current Texicare insurance card

• A photo identification card

• Your member and group identification numbers

• A current medication list

• Known medication or food allergies

• Relevant medical records

• Recent laboratory or imaging results

• Referral or authorization documents

• A description of your symptoms

• The date your symptoms began

• Your preferred pharmacy information

• Your benefit-verification reference number

• Questions for the medical professional

Choose a quiet, private space with reliable internet access and adequate lighting. Make sure your device is charged and that its camera, microphone, and speakers work correctly.

The patient must remain physically located in Texas throughout the appointment.

What Should I Expect During the Appointment?

The medical professional will review your symptoms, health history, medications, allergies, and current concerns. Depending on the reason for your appointment, you may be asked to describe or show a visible symptom using your device’s camera.

The recommended care plan may include:

• Medication recommendations

• At-home care instructions

• Laboratory testing

• Diagnostic imaging

• An in-person examination

• A follow-up appointment

• A specialist referral

• Emergency evaluation when necessary

A prescription is not guaranteed. Any medication decision will be based on the medical professional’s evaluation and what is clinically appropriate.

Are Prescriptions and Testing Covered Separately?

The cost of the virtual appointment may not include prescriptions, laboratory testing, imaging, or other services ordered after the visit.

Before completing recommended testing or filling a prescription, ask Texicare:

• Is the medication on my plan’s formulary?

• Does it require prior authorization?

• Is there a preferred pharmacy?

• Which laboratory is in network?

• Does the test require authorization?

• Will the service apply to my deductible?

• What copay or coinsurance may apply?

Texicare has identified Quest Diagnostics as its exclusive clinical laboratory provider for members using its proprietary network. Members should confirm whether this requirement applies to their exact plan before completing laboratory testing.

Claims and Billing Information

Claims should be submitted using the information associated with the member’s exact Texicare plan.

Providers should verify:

• Electronic payer identification number

• Claims mailing address

• Member eligibility

• Plan and network name

• Telehealth coverage

• Primary and urgent care benefits

• Provider participation

• Prior-authorization requirements

• Referral requirements

• Timely filing limits

Current claims instructions should be confirmed using the member’s insurance card or Texicare’s provider resources. Providers should not rely on information associated with another employer, plan, or network.

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 Virtual Care Wherever You Feel Comfortable

VirtualCare2go makes it easier to speak with a medical professional when traveling to a clinic feels inconvenient or uncomfortable. The medical team will listen to your concerns, determine whether virtual care is appropriate, and clearly explain the recommended next step.

When you are ready, book a virtual medical visit or call (817) 508-8169. Have your Texicare insurance card available so your eligibility, telehealth benefits, and network participation can be reviewed before the appointment.