Scott & White Health Plan Insurance Review & Complaints: Health Insurance (2023)

Texas-based Scott & White Health Plan is a managed care organization providing health insurance plans to a large portion of the state. They offer individual and group plans as well as supplemental health insurance coverage.

What is Scott & White Health Plan?

Baylor Scott & White Health Plan was founded in 1982 as Centroplex Health Plan, a managed care health insurance provider in only two counties. The insurance company has since changed the name to Scott & White, which goes back to the opening of Temple Sanitarium in 1904 by two doctors: Dr Arthur C. Scott and Dr Raleigh R. White, Jr. It eventually became Scott & White Medical Center.

Scott & White has a network of 60 clinics and hospitals throughout Texas. They serve more than 275,000 members in 77 counties. In 2013, Scott & White merged with Baylor Health Care to form Baylor Scott & White, the largest not-for-profit healthcare systems in Texas.

Today Scott & White offers both HMO and PPO plans, as well as dental, life, Medicaid, and Medicare Part D plans. Not all plans are underwritten directly but are instead offered through a partnership with another company. They also write group health plans for employers of all sizes. In 2017, Scott & White stopped offering plans through the healthcare marketplace and now sells only directly.

What products are offered by Scott & White?

Scott & White offers a limited selection of individual and family health plans as well as a variety of supplemental insurance options.

Individual HMO

There is only one HMO plan listed on the Scott & White website. This is a Bronze plan, which means it is designed to have low monthly costs with higher out-of-pocket expenses when you use it. As an HMO, there is no coverage for out-of-network care, except in emergencies.

The HMO 6400/50v plan has an individual deductible of $6,400 and a family deductible of $12,800. Nearly all services are subject to the deductible, with the exception of one office visit and one urgent care visit per year at a $50 copay. After the deductible is met, the plan pays 80%.

There is no separate prescription drug deductible. Preferred generic (Tier 1) drugs are covered with a $17 copay, and all other drugs are subject to the deductible, after which they are covered at 50%.

Individual PPO

Scott & White again lists only one PPO plan on the website at the bronze level the Bronze PPO 7150. This plan offers both in and out-of-network coverage.

The in-network deductibles for this plan are $7,150 individual and $14,300 family. For out-of-network care, the deductibles double to $14,300 individual and $28,600 family. For both, the out-of-pocket max is the same as the deductible.

In-network, the plan has a $60 copay for the first two office visits and a $100 copay for the first two specialist visits. All other services are subject to the deductible, after which the plan pays 100%. Out-of-network care requires that the deductible is paid before any coverage is available, after which the plan pays 50% for most services and 100% for urgent care and emergency care.

Prescription drugs have a $40 copay for Tier 1 and a $100 copay for Tier 2. Other tiers are covered at 50% after the deductible.

Dental Insurance

Dental Insurance Scott & White offers a separate dental plan, available for both adults and children. These plans are underwritten through a partnership with MetLife Life Insurance

Life Insurance

Like the dental plans, the term life insurance policies offered by Scott & White are actually underwritten and administered by MetLife. There are three term life options, with benefits ranging from $10,000 – $50,000.

Medicare Advantage

Scott & White’s Medicare Advantage plans are available either as an HMO or a PPO. There are several SeniorCare plans that vary in availability depending on the county of residence.

SeniorCare (Cost) HMO Plans

None of these HMO plans have a deductible, but copays and other coverage vary. There are four options.

The SeniorCare Select HMO is the basic plan, with a $0 monthly premium on top of your Medicare Part B coverage. This plan offers a $20 copay for primary care visits and a $50co pay for specialists.

The SeniorCare Preferred HMO has an added premium, and has a $15 copay for both primary care and specialist visits, with a lower out of pocket maximum. Copays are lower for most services.

Increasing again in price, the SeniorCare VIP HMO has a $10 copay for primary care and specialist visits.

The SeniorCare Premium HMO is the most expensive of this group of plans, with a $0 copay for office visits and for several other services.

SeniorCare Advantage PPO Plan

The SeniorCare Advantage PPO plan offers both in and out-of-network coverage. There is no copay for primary care office visits, and specialist visits are covered with a $40 copay. While there is no deductible for in-network care, there is a $750 deductible out-of-network.

SeniorCare Advantage HMO Plan

This plan is similar to the Advantage PPO, but does not offer the out-of-network coverage option. The primary care visit copay is $0, and office visits are $40. Like all of the plans, there is no deductible.

SeniorCare Vital Traditions HMO

This is the second plan from Baylor Scott & White Insurance Company that has no added premium beyond regular Medicare premiums. Primary care visits have no copay, and specialist visits have a $45 copay. Again there is no deductible, and as an HMO this plan has no out-of-network coverage.

Group Health

Scott & White offers different plans based on the size of the employer. These also include HMO, PPO, and dental insurance plans. Self-insured plans are also available, as well as voluntary employee benefits including life, accident, and other health care services.

Are Scott & White’s rates affordable?

Rates for the individual health plans are not offered on the Scott & White website, nor is online quoting offered. We would expect rates to be reasonable based on the coverage offered – all plans are Bronze level with high out-of-pocket costs.

Medicare Advantage rates are available, although they vary based on the area of the state in which the member lives. As noted, there are two $0 premium Medicare plans. The plan with the highest rates is the HMO Premium at $183/month. The rest of the plans fall somewhere in between, with most options costing less than $100/month.

Since this company serves only Texas, we are unable to compare the rates of health plans to the rest of the country. The Medicare Advantage rates do fall in line with what we have seen elsewhere.

How are claims handled?

The insurer will pay most claims directly to the provider, as with most health insurance plans. Members can likely expect that in-network claims will be paid a bit faster, as they are within the same system.

It is not unusual to see that claim information is not readily available on the website. This is common for health insurance companies that rarely pay claims directly to members. Although their claims department should have some customer service advocates on hand to answer questions or handle your claim appeal.

Does the company have positive ratings and consumer reviews?

The Better Business Bureau (BBB) page we located for Scott & White Health Plan states the lack of rating is because complaints are handled by another BBB listing. Listed under Baylor Scott & White Health, and what appears to be the main page for the merged companies, there is a B rating. There are 84 complaints on file in the past three years, with 24 of those closed in the past twelve months. The BBB states that the lowered rating is the result of two complaints that were not responded to, and three that were not resolved.

Yelp has 27 reviews of Scott & White Health Plans, with an overall 1.5-star rating. Many complaints focus on customer service issues and failure to pay claims as expected. Several people listed long wait times to speak to someone, and difficulty with billing.

Complaints against this company are similar to those we see for many insurers. It is difficult to determine complaint volume due to the merged BBB page with Baylor Health. Overall, however, complaint volume is not at a level that would concern us. It is always of some concern, however, to see complaints unresolved or ignored on the BBB.

What’s the bottom line?

Scott & White have limited health plan options, and their withdrawal from the marketplace may lead some customers to look elsewhere. Without rates, it is difficult to compare, but unless the plans are at a very low price point, it seems likely that the average shopper could find better coverage elsewhere. On the Medicare side, the rates appear reasonable and the coverage comprehensive, so this company might be a good pick for anyone seeking a local Medicare Advantage insurance provider.