The provider network that is available to you under the terms of your plan is made up of independently contracted doctors, hospitals and other health care providers. The contracted providers in your network do not work for or are part of BCBSTX. However, they do have agreements with us, BCBSTX, that may help save you money for covered services.
Your costs will vary depending on whether your provider is participating in the network. Please refer to Provider Finder® to find in-network providers. You should check if your plan has out-of-network benefit coverage before scheduling a visit.
Your Network and Your Plan Type
The way you use the provider network available under your health plan may vary by your plan type. The following is a brief description of how each plan type works.
Health Maintenance Organization (HMO)
If you have an HMO, you must work with a contracted (in-network) primary care physician (PCP) to help coordinate any care you receive within your provider network. When you first sign up for an HMO, you choose, or are assigned, a PCP.
Your PCP is your partner to help guide you with your health care needs. When using your HMO plan, keep in mind the following:
- You must work with your PCP whenever you need care. When you first choose or are assigned a PCP, schedule a visit as soon as possible. Going right away will help avoid delays later when you are sick or need a referral.
- You will need a referral to see a specialist. If you need to see a specialist, you must obtain a referral from your PCP. Your PCP will usually refer you to a specialist that is in your network, but you should always check to make sure. Women don't need a referral to see an in-network OB-GYN, which is an obstetrician/gynecologist or a family practice doctor.
- You must see in-network providers. For non-emergency care, HMO members must stay in network to receive benefits, except in limited circumstances as stated in your policy. Otherwise, you will be responsible for paying the entire cost of an out-of-network provider visit. To ensure you stay in network, consult with your PCP. If you want to select a new PCP, search Provider Finder before visiting a new doctor or health care facility to make sure that the PCP is in your network.
Point of Service (POS)
If you have a POS plan, you have an HMO plan that also includes certain out-of-network benefits. When using your POS plan, keep the following in mind:
- You must work with a PCP. POS members needs to work with a primary care physician (PCP) who will help coordinate your care. Your PCP should be your first stop when you need medical care.
- You don’t need a referral to see a specialist. Even though you do not need referrals, your PCP can still help you make decisions about your treatment and recommend if a specialist is right for you. If your doctor does refer you to a specialist, you will still want to verify that the provider is in your network.
- You can receive out-of-network care. Because POS members also have out-of-network benefits, you can visit a doctor or health care facility outside your provider network with a POS plan. However, you will usually pay more for your services out-of-pocket if you do not stay in network.
To make sure a provider is in your plan's network, search Provider Finder before visiting a new doctor or health care facility.