Insurance Plans and Information

The following information will help you understand how Edinburg Children's Hospital handles insurance. All patients should familiarize themselves with the terms of their insurance coverage. Understanding your benefits will help you understand the hospital’s billing procedures and charges. If you have any questions about your charges, please feel free to contact our Business Office Customer Service Department at 1-800-386-1747.

Accepted Health Plans

View all of the accepted health plans at Edinburg Children's Hospital. Please realize that some managed care organizations may be added, while others may be removed at any time. Please contact Insurance Verification at 956-388-2223 or 956-388-2228.

If You Have Health Insurance For Your Child

We will need a copy of your insurance card and any insurance forms that are required by your employer or the insurance company. Deductibles and co-payments are the responsibility of the patient or guardian. You will be asked to assign benefits from the insurance company directly to the hospital. This authorizes your insurance company to pay the hospital directly for services rendered to you. Please contact your insurance company for questions regarding your coverage.

If You Are a Member of an HMO or PPO

Your plan may have special requirements, such as prior authorization. It is your responsibility to make sure that you understand these requirements. If your plan’s requirements are not followed, you may be financially responsible for all or part of the services rendered in the hospital.

Deductibles and co-payments are also the responsibility of the patient. Some physician specialists may not participate in your health care plan and their services may not be covered. Please contact your insurance company for questions regarding your coverage.

If You are Covered by Medicare

Children can receive Medicare and other government-related healthcare if they meet certain conditions. To qualify for Medicare, children must be disabled and checked through the Social Security Administration.

You should be aware that the Medicare program specifically excludes coverage for certain items and services. Deductibles and co-payments are also the responsibility of the patient. Some medications given in an outpatient setting may not be covered.

If Your Child Is Covered by Medicaid

Medicaid provides health coverage for eligible low-income adults, children and people with disabilities. Medicaid has payment limitations on a number of services and items. Medicaid does not pay for the cost of a private room unless medically necessary.

Children’s Health Insurance Program

The Children’s Health Insurance Program (CHIP) provides health coverage to eligible children, through both Medicaid and separate CHIP programs. CHIP is administered by states, according to federal requirements. The program is funded jointly by states and the federal government. Learn more about CHIP >

If You Do Not Have Health Insurance For Your Child 

A representative from the Financial Counseling Office will discuss financial arrangements with you. Edinburg Regional Medical Center has representatives available to assist you in applying for Medicare, Medicaid, county assistance and for our Charity Care program. All programs, including Charity Care, have qualifications that must be met. If you do not meet these qualifications, you are still financially responsible for your hospital bill.