INSURANCE & COVERAGE
Insurance Accepted
Lakeside Medical Group currently accepts Original Medicare Part B, select Medicare Advantage HMO plans, Medicare PPO plans, and private-pay.
Original Medicare Part B
Medicare Advantage HMO
Medicare PPO Plans
Private-Pay
IN-NETWORK PLANS
Insurance Plans We Accept
We are in-network with the following plans:
Original Medicare
(Part B)
Humana HMO/PPO
Community
First HMO/PPO
Blue Cross
Blue Shield of
Texas PPO
United
Healthcare PPO
Aetna PPO
Cigna PPO
TriCare*
*Please contact our office to confirm current TriCare acceptance.
OUT-OF-NETWORK OPTIONS
What If My Plan Isn't Listed?
At this time, we are not yet contracted with other HMO plans. However, we're still happy to see you and bill your insurance company on your behalf. Please note that most HMO plans will require us to bill you directly for the full cost of the visit, since we are outside your plan's network. As a general guide:
Initial Visit
~$200
Follow-Up Visit
~$150
Chronic Care Mgmt
~$40–$50/20min
A note on availability: We have reached out to other HMO insurance companies about joining their networks,
but as of now, all of them have told us their panels are closed for Comal County. We will continue pursuing
these contracts so that more families can access our services through their insurance.
PRIVATE-PAY
Private Pay Pricing
If you don't have insurance, or prefer to pay directly, our pricing is based on the Medicare fee
schedule. Here are our current estimated rates:
Initial Visit (MD/NP)
Standard $150.98
Higher-complexity $215.88
NP without MD present: 85% of these rates.
Follow-Up Visit (MD/NP)
Standard $141.41
Higher-complexity $198.42
NP without MD present: 85% of these rates.
Chronic Care Mgmt
Phone / care coordination with
nursing staff
First 20 min $70.31
Each add'l 20 min $53.51
TRANSPARENCY
Our Commitment to You
We know medical bills can be confusing and stressful, especially when you're caring for a loved
one at home. We do our best to:
Stick to the billing codes and rates listed above whenever possible
Clearly communicate if a higher level of care will require additional charges
Be upfront and transparent about costs before they come as a surprise
Please note: Your specific copay, coverage, and out-of-pocket costs depend on your individual insurance
policy. We encourage you to check with your plan directly for details on your benefits.
FAQS
Insurance & Billing Questions
What insurance plans does Lakeside Medical Group accept?
We are in-network with Original Medicare (Part B), Humana HMO/PPO, Community First HMO/PPO, Blue Cross Blue Shield of Texas PPO, United Healthcare PPO, Aetna PPO, Cigna PPO, and TriCare (please contact our office to confirm current TriCare acceptance).
What if my insurance plan isn't listed?
We are not yet contracted with other HMO plans, but we're still happy to see you and bill your insurance
company on your behalf. Since we're outside your plan's network, most HMO plans will require us to bill
you directly for the full cost of the visit — approximately $200 for an initial visit, $150 for a follow-up, and
$40–$50 per 20 minutes of chronic care management.
Are you working to join more insurance networks?
Yes. We have reached out to other HMO insurance companies about joining their networks, but as of now,
all of them have told us their panels are closed for Comal County. We will continue pursuing these
contracts so more families can access our services through their insurance.
What if I don't have insurance or prefer to pay directly?
Our private-pay pricing is based on the Medicare fee schedule: an initial visit is $150.98 (or $215.88 for a
higher-complexity or longer visit), a follow-up visit is $141.41 (or $198.42), and ongoing chronic care
management is $70.31 for the first 20 minutes and $53.51 for each additional 20 minutes. Visits with a
Nurse Practitioner without an MD present are billed at 85% of these rates.
Will I know about costs before they come as a surprise?
Yes. We do our best to stick to the billing codes and rates listed on this page, clearly communicate if a
higher level of care will require additional charges, and be upfront and transparent about costs before
your visit.
How do I find out exactly what my plan covers?
Your specific copay, coverage, and out-of-pocket costs depend on your individual insurance policy, so we
encourage you to check with your plan directly for details on your benefits. Our team is also happy to help
— just call us at 830-264-7769.
Questions
If you have any questions about insurance, billing, or whether we accept your
plan, please don't hesitate to reach out — we're happy to help you figure out
your options.