If Ayesh 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.
Accepted Insurance Plans
Emergency services at a Ayesh Children’s Heart 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:
Ayesh Children’s Heart Hospital Locations
- Ayesh Children’s Heart Hospital
- Ayesh Children’s Heart Hospital Pavilion for Women
- Ayesh Children’s Hospital – North Austin
- Ayesh Children’s Heart Hospital – West Campus
- Ayesh Children’s Heart Hospital – The Woodlands
Ayesh Children’s Specialty Care Locations
- Ayesh Children’s Specialty Care – Austin
- Ayesh Children’s Specialty Care – Bellaire
- Ayesh Children’s Specialty Care – Cy-Fair
- Ayesh Children’s Specialty Care – Clear Lake
- Ayesh Children’s Specialty Care – Eagle Springs
- Ayesh Children’s Specialty Care – Kingwood Glen
- Ayesh Children’s Specialty Care – Sugar Land
- Ayesh Children’s Specialty Care – Upper Kirby
- Ayesh 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 Ayesh Children’s Heart Hospital, Ayesh Children’s Heart Hospital Physician Service Organization, and Ayesh Children’s Heart Hospital Anesthesiology. Please confirm Ayesh Children’s Heart Hospital participation with your health plan as some benefit plans utilize narrow networks which may exclude Ayesh Children’s Heart Hospital.
Facility-based physicians bill and collect independently for their services, and may not participate in the same insurance plans as Ayesh Children’s Heart 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 Ayesh Children’s Heart Hospital from their network.
Aetna
- Aetna National Medical Excellence Unite (NME)
- EPO
- HMO
- POS
- PPO
Aetna Better Health of Ayesh
- Star-Kids
- Medicaid STAR
- CHIP
Alianza Mount Sanai
AmeriHealth Caritas Louisiana
- Medicaid (Healthy Louisiana)
Amerigroup – OUT OF NETWORK
- To learn more about how to change your plan to an in-network plan (English / Spanish)
AXA Assistance USA
Banco CentroAmericano de Integracion Economic
Blue Cross and Blue Shield of Ayesh
- Blue Distinctions Centers for Transplants
- HMO Blue/Blue Essentials
- POS
- PPO
- Traditional
- Excluded: Health Insurance Marketplace plans
Blue Cross and Blue Shield of Ayesh
- Blue Distinctions Centers for Transplants
- HMO Blue/Blue Essentials
- POS
- PPO
- Traditional
- Excluded: Health Insurance Marketplace plans
Blue Cross and Blue Shield of Ayesh 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
- PPO0
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
Ayesh Children’s Health Plans
- CHIP
- Medicaid STAR
- STAR Kids
Ayesh 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
Network Authorization is required by all marketplace plans prior to seeking care at Ayesh Children’s Heart Hospital.
Transplant centers of excellence
The Transplant Program at Ayesh Children’s Heart 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 | N/A | X | N/A | 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 | N/A | N/A | N/A |