How do I know if ARC accepts my insurance?

You can view a list of the major insurance companies that we accept on our web site. If your plan is not listed, you can call 512-ARC-INFO at 512-272-4636 or call your insurance company to find out if Austin Regional Clinic is covered under your health plan.

What is the difference between In-network and Out-of-network?

There are two levels of coverage in most health plans: In-network and Out-of-network. Out-of-pocket costs in both levels of coverage may include: office visit co-payments, deductibles and coinsurance.
  • In-network This level of benefits applies when you use a physician, specialist, or other provider who is a network member. By utilizing In-network providers, you will pay lower co-payments, deductibles, and coinsurance than you will using Out-of-network providers.
  • Out-of-network This level of benefits applies when you call or see a physician, specialist, or other provider who is not a network member. You are responsible for any amounts incurred in excess of the "covered charges." "Covered charges" are pre-determined usual, customary and reasonable charges for a particular service. You must call your health plan to learn more about your covered charges.

How do I know what benefits are covered?

You will need to call your insurance company directly or your employer's benefit office to find out what your benefits are.

How do I know what my co-pay is?

The co-pay amount is usually listed on your insurance card. If it is not there you will need to call your insurance company to find out your co-pay amount.

What is a PCP?

PCP stands for Primary Care Physician. This would be the physician that you see on a regular basis.

What is the difference between a guarantor and a subscriber?

  • A guarantor is the adult financially responsible for a patient’s account after insurance payments have been made. The guarantor is usually the patient unless the patient is a minor or otherwise incapacitated adult.
  • A subscriber is the main person enrolled in the insurance plan often times through an employer and may also be referred to as the primary insured.

What if I need help finding the right Medicare plan for me?

ARC accepts a variety of Medicare insurance plans. Please note that we do not participate with every Medicare plan offered in the area. If you need help comparing and choosing a Medicare plan, we recommend the Medicare Plan Comparison and Enrollment Center (toll-free: 1-866-391-7582), serviced by MedicareCompareUSA*. Visit our MedicareCompareUSA page for more information.

*MedicareCompareUSA is not affiliated with the Federal Medicare program. MedicareCompareUSA is a licensed Medicare-specialty insurance agency. Services of MedicareCompareUSA are provided to Medicare beneficiaries at no cost; MedicareCompareUSA compensated directly by the Medicare plans accepted by Austin Regional Clinic.

How do I update my insurance information with ARC?

To update your insurance information with us, please call Central Registration at 512-407-6446. You will need all of your new health insurance information on hand for this phone call as well as any personal information that has changed. If you have an insurance plan that must be renewed monthly, it is smart to call and update the information with Central Registration before your visit. This can prevent you from being delayed at the front desk or having an appointment rescheduled because your insurance is no longer compatible with ARC.

What do Indemnity, PPO, HMO, and POS mean and what is the difference between them?

  • INDEMNITY A fee-for-service (FFS) traditional payment plan. The covered person and the insurance carrier pay a percentage of the allowable charge for the service rendered. The policy holder may choose the physician, hospital, or other healthcare provider without restriction. Pre-set deductibles are required (often referred to as 80/20 plan).
  • PPO (Preferred Provider Organization) - Also a fee-for-service plan, but the covered person is required to use a physician, hospital, or healthcare provider from the plan's Preferred Provider list for In-network benefits. Usually PPO contracts provide significantly better benefits in exchange for the policy holder's agreement to stick to the preferred providers. If you use Out-of-network providers, your out-of-pocket expenses will be higher, and some services may not be covered.
  • HMO (Health Maintenance Organization) An HMO is a group that contracts with medical facilities, physicians, employers and sometimes individual patients to provide medical care to a group of individuals. This care is usually paid for by an employer at a fixed price per patient. There is no annual deductible and members pay a flat co-payment rather than a percentage of the allowed charge. Your care is coordinated by a Primary Care Physician (PCP) who determines how, when and where you will be treated, as well as what specialists and hospitals you may be referred to. These plans do not provide for any Out-of-network care except in emergencies and special cases.
  • POS (Point of Service) - Plans that combine features of an HMO and a PPO. Out-of-network care is covered. The plan may provide for a primary care physician, but you will have access to a wider range of doctors, as in a PPO plan. If you choose to use In-network providers, a flat co-payment applies; Out-of-network care requires higher deductibles and higher out-of-pocket expenses.

These plans do not affect Medicaid coverage, Medicare supplements, or Medicare benefits.