This article is intended for members enrolled in an individual health insurance plan.
Those personal life details we suggest you share with your providers can impact your health. There are also some key communications that may impact your coverage and cost sharing.
Your Member ID Card
There are a few important things to keep in mind about your coverage when you visit your doctor. The most basic of these is information about your current health plan.
You should have received a new member ID card for this year, even if your plan did not change. Be sure to bring your current member ID card to your appointments and share it with your doctor’s staff. It’s the key to making sure your claims are processed correctly.
Your plan may have changed if you chose a different plan or were moved to a new plan. Even if you are in a plan with a name like that of your previous plan, there may be a different number at the end of the name. That number is important for provider office staff to have for filing your claims.
There are important details on the card that can help you and your provider keep track of your current benefits:
- Plan name and type
- Network name
- Your provider name or practice (in some cases)
- Copays and coinsurance
- Contact information for questions about your coverage
If you can’t find your card, log in to Blue Access for MembersSM (BAMSM), our secure member website, to print out a temporary one. After you log in, click on the My Coverage tab and look for the image of an ID card. Click on that image and follow the instructions to print your temporary card and order a new one.
If you’re not already registered for BAM, register today. It’s easy. Just go to bcbstx.com/member/register and follow the instructions.
There is important information to know about your providers. First, remember there are times when providers join or leave networks. There can be many reasons for this. They may change practices, relocate or retire. Whatever the reason, your coverage may be different if you see a provider or providers who are not in your network. So it’s important to keep track.
Some plans do cover services out of network, but at a higher out-of-pocket cost to you with no out-of-pocket limit. Some plans may not cover out-of-network services at all.
To avoid surprise bills, confirm that your providers are in network each time you make an appointment. This applies to prescription drug and dental coverage, too.
You can confirm your pharmacy, doctor, hospital or health care facility is in network by logging in to BAM and using Provider Finder® under the Doctors and Hospitals tab.
Talking about money is rarely easy. Yet everyone has a bottom line. If your plan has a deductible that you must meet before your coverage starts paying claims, that is the amount you must pay out of pocket.
If you have cash on hand and you know you will have health care needs during the year, it may make sense to get as much done as soon as you can to go ahead and meet your deductible. Stack those appointments, tests or procedures as close as your doctor thinks is right for your optimal health.
If cash flow is tight, ask if you can space things out a bit.
You may have seen or be seeing more than one provider. Your plan may require referrals from a primary care provider. If so, your primary care doctor will help coordinate your care from other doctors.
If referrals are not coordinated by your primary care doctor, make sure each provider you see knows that you are seeing other doctors.
And in either case, be sure to tell each doctor who the others are, how to reach them, what they are seeing you for, and any treatment or drugs they prescribed.