My Coverage Explained

How to Use Health Insurance

How to Use Health Insurance

If you have a new health insurance plan, you probably have questions about how to use it. The two questions we get the most are “how do I choose a doctor?” and “how do I get prescriptions?”.

How to Find (the right)  Doctor

Congrats on your new health insurance! Now it’s time to choose a doctor and make the most of your benefits. Choosing the one who is right for you is just that— a choice. Here are some tips on how to find a doctor or another health care provider to meet your needs::

  • DoctorCall us or use the Provider Finder  tool on our website to find nearby doctors who are in your health plan's network  and will accept your insurance plan. Don’t skip this step. It means lower out-of-pocket costs for you!
  • Talk to family members, friends and co-workers to see if they have any recommendations. Ask them what they like and don’t like about each doctor. There are even some websites dedicated to doctor reviews and ratings
  • Narrow down your choices. When you have found a few doctors you’re interested in, call their offices. Ask these questions to help you decide:
    • Are they accepting new patients?
    • Is the office close to your home or your work? Will it be easy for you to get there?
    • When is the office open? Are evening or weekend appointments offered?
    • Does the doctor or someone in the office speak your language?
    • Which hospital(s) does the doctor use to see patients?
    • How long does it take to get an appointment?

Pick a doctor and test the waters. Schedule a visit and pay attention to how comfortable you feel talking with the doctor.
If you’re not comfortable with your doctor, then it’s not a good fit and you should look for another one.

How to Get Prescriptions

Prescription drugs are an important part of your new health coverage. Your health plan will help pay the cost of certain drugs. To find out if your prescriptions are covered by your plan, log in to your account in Blue Access for MembersSM from our website. This list is also called a formulary or drug list. To look for your medicines, you will need to know:

  • The medicine's exact name
  • The dose you are prescribed
  • The quantity of medication your doctor often prescribes

If prescription medicine you take isn’t covered under your formulary, you can take these steps:

  • Talk to your doctor about options. A generic version  or another covered drug could be a better choice for you.
  • Your doctor can ask that your insurer cover a drug not on its formulary if there is a health need.  If the request is denied, you have the right to appeal your health plan's decision and provide information to support your need for the drug.

Where to Get Medications

Your new health insurance allows you to get your medications from many drug stores (called "network" pharmacies). Use the Provider Finder  tool and select “pharmacies” to find out if your regular pharmacy is in your health plan's network and, if not, to find a network pharmacy near you. You might even be able to get your prescriptions delivered to you in the mail. Mail order prescriptions may cost you less.

Still looking for more information? Here’s how to make the most of your prescription drug benefits and new health insurance.

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