My Coverage Explained
Picking out a health insurance plan is half the battle, but there's still more work to do. We know you have questions, so we have answers! Follow these steps to find a doctor in your network.
You've picked out your health insurance plan, now take the next step and find a doctor. If you're one of the millions of Americans who recently enrolled in health insurance for the first time, then good for you! It was probably one of the most important things you did this year. Now that you're covered, you can move on to the next big step. Find a doctor who's right for you. Don't worry, we'll walk you through how to do it:
Know what types of doctors you're looking for:
If you don't already have one, you'll want to find a general practice doctor and set up a first visit. This doctor can be a family practice or general internal medicine doctor. For the kids, you can use a pediatrician. If you are a women, you can us your gynecologist. Essentially, you just need a doctor who can do a thorough checkup for health issues that may need to be treated.
If you have an HMO plan, this doctor will be your primary care physician, or PCP. You should have picked a PCP when you enrolled, but if you didn't, then we assigned one to you. If you have a PCP but want to change to another doctor, you can call Customer Service at the number listed on your member ID card. You can also register and log in to your Blue Access for MembersSM account, then select "Change PCP" form the Doctors & Hospitals section.
Your PCP will track your care and even help you find a specialist, such as a heart doctor or surgeon, if you need one. Always make sure any specialist you see or hospital you visit is in your network. Without a referral from your PCP to a network specialist, you could end up paying the full cost of your care.
Know where to look:
Your health plan has a certain group of doctors you can choose from. It also has a list of hospitals, clinics and other medical services you can use. This is your plan's provider network. The network agreement outlines what tests and treatments we'll cover, how much we'll pay them for their services, and where certain medical test or procedures can be done under your plan's benefits. This agreement protects our members from paying unknown charges.
For you, this means you have to find a doctor in your plan's network in order to have your visits and treatment paid for by your insurance at the best rate. Networks vary from plan to plan, so make sure you know the in-network doctors for the health plan you bought. If you're not sure, check before you go! Call Customer Service at the number listed on your member ID card or enter your plan name in our Provider Finder tool to pull up a full list. If you want to find certain types of doctors, you can search by specialties.
Want more tips? Check out How to Find (the right) Doctor.
Make Your First Appointment
Your new doctor will want you to schedule a visit and get set up as a new patient as soon as possible. At the first appointment your doctor will ask you questions about your medical history, do a physical exam, take your blood pressure, draw blood to check for diabetes and other health conditions, and possibly even screen for cancer. You might think you're healthy and don't need to waste your time with a visit. However, it doesn't take long and probably won't cost you anything. Most preventive care is covered in full by your insurance. If you want to find out for sure, call your doctor's office and have them look it up before you schedule an appointment.
Make the most of your health plan by using it to stay healthy, rather than waiting until you get sick. Spending a little money now to see a doctor and get the health care basics covered saves you money down the road and could save you from a lifetime of illness.
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