BCBS HMO Providers: A Comprehensive Guide to Choosing a Provider

Choosing a Blue Cross Blue Shield (BCBS) HMO provider can be a daunting task, especially with so many options available. There are over 100 BCBS HMO plans across the country, each with its own network of providers.

To start, it's essential to consider your individual needs and priorities. For example, if you have a chronic condition, you may want to look for a provider with a strong reputation for treating your specific condition.

The BCBS HMO network is vast, covering over 90% of the US population. This means you'll likely have many options to choose from, but it also means you'll need to research carefully to find the best fit for you.

Choosing a doctor and hospital is a crucial step in getting the best possible care. You have several options when it comes to types of primary care physicians (PCPs).

Family/general practice, internal medicine, obstetrics/gynecology, and pediatrics are the main types of PCPs. Each specializes in different areas of medicine.

To choose a PCP, consider factors like whether the physician is accepting new patients, location, number of specialists, and hospital affiliation. Most PCPs are board certified or board eligible for their type of practice or specialty.

You can find a PCP by searching online or through your health insurance provider's database. Key information needed for selecting a physician includes the physician's first and last name, 9-digit provider number, and medical group/IPA's 6-digit number.

Medical groups and IPAs are organizations of physicians who provide a range of services to health plan members. If you're an Access+ HMO member, you can go directly to a specialist within your PCP's medical group or IPA.

Here are some key things to consider when choosing a PCP:

If you're planning to travel, you can use the BlueCard program to see a Blue Cross Blue Shield provider anywhere in the United States. More than 85% of all hospitals and healthcare providers nationwide participate with a Blue Cross Blue Shield plan.

To find Blue Advantage providers in your area, you can search the directory online. This will quickly give you a list of plan providers nearest your home.

You can also contact Member Services for help getting additional directories or finding in-network providers if you're traveling outside of the service area.

The hard copy provider directory is available in a different format, including large print, if needed. Simply contact the Member Service Department to request it.

It's worth noting that the provider network may change at any time, and you'll receive notice when necessary.

Seeing in-network providers gets you the most value for your money, and you'll find many types of providers and specialties in the network.

If you're outside of the plan's service area and need urgent medical care, the plan will cover urgently needed care from any provider at the lower, in-network, cost-sharing amount. This means you can get the care you need without worrying about high costs.

In emergency situations, you can get covered, emergency, medical care anywhere in the United States or its territories. The plan covers ambulance services if getting to the emergency room by any other means could endanger your health.

If you have an emergency, the doctors giving you emergency care will decide when your condition is stable and the medical emergency is over. You're entitled to follow-up care to ensure your condition continues to be stable, and your follow-up care will be covered by the plan.

However, if it turns out that it wasn't a medical emergency, you'll still be covered as long as you reasonably thought your health was in serious danger. But, if you get care from out-of-network providers, your share of the costs will be higher.

Here are some key things to remember about urgent medical care:

To get the most value from your BCBS HMO plan, choose in-network providers. You'll find many types of providers and specialties in the network, including primary care, cardiology, rheumatology, and urology.

Scheduling a visit with your primary care provider (PCP) soon after your coverage effective date is a good idea. This will help you stay on top of your healthcare and catch any potential issues early on.

Choosing in-network providers can save you money and ensure that your care is coordinated. You'll also have access to a wide range of specialists and services within the network.

Your primary care provider can let you know if you'll need a referral to see a specialist. This will help you avoid any unexpected costs or complications down the line.

You can quickly find a Blue Advantage provider in your area by searching the directory on the Blue Cross Blue Shield website. This directory will give you a list of in-network providers nearest your home.

If you're traveling outside of the service area, you can contact Member Services for help getting additional directories or finding out if there are in-network providers in that area.

As a Blue Advantage member, you have the flexibility to see either in-network or out-of-network providers, as long as the services are covered benefits and medically necessary. However, using an out-of-network provider may result in higher costs for your covered services.

To find a primary care physician (PCP), you can use the find a doctor tool on the Blue Shield website. You'll need to provide the physician's first and last name, 9-digit provider number, and medical group/IPA's 6-digit number.

When choosing a PCP, consider factors such as whether the physician is accepting new patients, location, number of specialists, hospital affiliation, and board certification.

Here are some types of PCPs you may encounter:

To use the Access+ Specialist option, you'll need to select a PCP whose medical group or IPA participates in the program.

If your PCP retires or leaves the network, Blue Shield will select another PCP for you and notify you in writing. If you're not satisfied with the selection, you can choose a different PCP.

If you're traveling, you can use the BlueCard program to find a Blue Cross Blue Shield provider anywhere in the United States. With your BCBSND identification card, you'll receive the same provider discounts as in-state residents.

You can also use the provider search tools to find dental and vision providers in your area.