Prism Electric Employees Access Virtual Medical Care

Prism Electric Coverage with VirtualCare2go™ Across Texas

When you or a family member needs medical attention, traveling to a clinic may not always be convenient. VirtualCare2go™ connects eligible patients with a medical professional through a secure online appointment.

VirtualCare2go’s Prism Electric insurance page states that the service accepts eligible Prism Electric employees and the Prism Electric Health Plan. Coverage, member costs, and network participation should still be verified before every appointment.

Patients must be physically located in Texas during the virtual visit.

What Prism Electric Plan Costs Apply?

The publicly available Prism Electric insurance page does not list plan-specific copays, deductibles, or coinsurance amounts.

Before scheduling, review the medical information printed on your insurance card or contact the plan administrator listed on the card. Ask what cost applies to:

• Virtual primary care

• Virtual urgent care

• Telehealth appointments

• Follow-up visits

• Laboratory testing

• Prescriptions

• In-person services ordered after the appointment

A telehealth copay may differ from a traditional office or urgent care copay. Laboratory testing, medications, imaging, procedures, and other services may be processed separately.

An insurance card does not guarantee coverage or payment. Current eligibility, medical necessity, network participation, authorization requirements, and the services provided may affect your final responsibility.

For scheduling assistance, call VirtualCare2go at (817) 508-8169.

Can Prism Electric Employees Use VirtualCare2go?

Eligible Prism Electric employees and their covered family members may be able to use VirtualCare2go for non-emergency medical concerns that can be safely evaluated online.

The virtual medical team may evaluate concerns such as:

• Cold and flu symptoms

• Cough, congestion, or sore throat

• Fever and body aches

• Mild allergy symptoms

• Headaches and migraines

• Nausea, vomiting, or diarrhea

• Urinary symptoms

• Minor infections

• Rashes and skin concerns

• Pink eye symptoms

• Medication questions

• Non-narcotic refill concerns

• Routine primary care concerns

• Certain follow-up appointments

• General health questions

Coverage depends on the member’s exact plan, current eligibility, medical needs, provider-network participation, and services provided.

Some symptoms cannot be safely diagnosed or treated through video. The medical professional may recommend an in-person examination, laboratory testing, imaging, urgent care, or emergency care.

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

Who Administers the Prism Electric Health Plan?

The plan administrator’s name and contact information should appear on the front or back of the Prism Electric insurance card.

The administrator can help members and providers confirm:

• Current eligibility

• Virtual-care coverage

• Copays, deductibles, and coinsurance

• Provider-network participation

• Prior-authorization requirements

• Referral requirements

• Claim status

• Claims-submission instructions

When requesting assistance, have the following information available:

• Member name

• Member identification number

• Group number

• Prism Electric plan name

• Requested virtual service

• Proposed appointment date

• The Texas location where the member will be during the visit

Different Prism Electric employees may have different plans or coverage requirements. Verify benefits using the exact information on the member’s insurance card.

How Do I Verify My Virtual-Care Benefits?

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

• Does VirtualCare2go participate with my exact Prism Electric plan?

• Is virtual primary or urgent care covered?

• What copay, deductible, or coinsurance applies?

• Are telephone-only appointments covered, or is video required?

• Are laboratory tests, prescriptions, 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 network, platform, or location restrictions?

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

VirtualCare2go can collect your insurance information before the appointment, but the administrator listed on your insurance card provides the official explanation of benefits. Final coverage is determined when the claim is processed.

Is Prior Authorization Required?

Prior-authorization requirements depend on the member’s exact plan and requested service.

Contact the plan administrator before receiving a service that may require approval. Ask whether authorization is required for:

• Virtual primary care

• Virtual urgent care

• Repeated telehealth appointments

• Laboratory testing

• Diagnostic imaging

• Specialist services

• Medical procedures

• Certain medications

Confirm whether the member, ordering provider, or treating provider must request authorization.

Prior authorization does not guarantee claim payment. Current eligibility, medical necessity, network participation, plan exclusions, and other requirements may affect coverage.

How Do I Confirm Network Participation?

Network information should be verified through the member-services number or provider-search website printed on the Prism Electric insurance card.

Ask the representative to confirm the participation of:

• VirtualCare2go

• The treating medical professional

• The requested virtual service

• Any laboratory, imaging center, pharmacy, or supporting provider

Provide the employer name, plan name, member identification number, requested service, and the member’s Texas location.

A medical professional may participate with one network but not every employer plan using that network. Confirm participation with the exact Prism Electric plan before receiving care.

Are Specialist Referrals Required?

The publicly available Prism Electric insurance page does not identify a general specialist-referral requirement.

Some plans require a referral from an assigned primary care provider before specialty care is covered. Other plans allow members to schedule directly but may still require prior authorization.

Contact the administrator listed on your insurance card and ask:

• Is a specialist referral required?

• Must the referral come from an assigned primary care provider?

• Can a referral be issued after a virtual appointment?

• Does the referral need to be submitted electronically?

• Is prior authorization also required?

Receiving specialty care without a required referral may result in additional member responsibility.

How Should I Prepare for My Virtual Appointment?

Before your appointment, prepare:

• Your Prism Electric insurance card

• A photo identification card

• A current medication list

• Known medication or food allergies

• Your preferred pharmacy information

• Relevant medical records

• Recent laboratory or imaging results

• Any referral or authorization documents

• Your benefit-verification reference number

• A list of symptoms and when they began

• A thermometer or blood-pressure monitor, if available

Choose a quiet, private place with reliable internet access. Test your device’s camera, microphone, speakers, and internet connection before the appointment.

Make sure you are physically located in Texas and can clearly tell the medical professional your current location in case emergency assistance is needed.

Claims Information for Providers

The electronic payer identification number and claims mailing address should be confirmed from the member’s insurance card before submitting a claim.

Providers should verify:

• Current eligibility

• The exact Prism Electric plan name

• The administrator responsible for claims

• The correct electronic payer ID

• The current claims mailing address

• Telehealth billing requirements

• Provider-network participation

• Authorization or referral requirements

• Timely-filing requirements

• Applicable place-of-service and modifier rules

Claims information may change. Providers should not use information from another employer plan solely because the insurance logos appear similar.

Compassionate Virtual Care Wherever You Are

VirtualCare2go helps make non-emergency medical care easier to access through a private online appointment. The medical professional will listen to your concerns, evaluate what can be safely assessed virtually, and explain whether testing or in-person care is needed.

When you are ready, book a virtual appointment or call (817) 508-8169. Please have your Prism Electric insurance card available so eligibility, benefits, network participation, and authorization requirements can be reviewed before your visit.