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Get Answers to Our Most Frequently Asked Questions

I have a question about new membership.

I have a question about buying health insurance.

I have a question about payments.

I have a question about my HMO.



How can I learn more about my benefits?

You can log in to Blue Access for Members 24/7 to access your benefits information or Call the Customer Service number on the back of your BCBSTX ID card.


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Are my medical records kept private?

Yes. We are committed to protecting your medical records, and have strict rules to make sure our staff and anyone who needs to see your records keep all your member information confidential. Your medical records or claims details may have to be reviewed. If so, precautions are taken to keep your information safe. In many cases your identity, such as name and address, will not be included in the information provided during the review.


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Has my coverage started? Can I use my health plan?

Your first premium payment activates your coverage, so you can start using your health plan within 1–2 days of making your payment, depending on how you pay.

After you've made your first payment and your coverage is activated, you can have health care expenses during that coverage gap applied to your deductible, or even get paid back for some services. In this case, the coverage gap would be the time between your requested effective date and the date you make your first payment.


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I need to get a prescription filled but don't have my ID card yet. What can I do?

Even if you haven't received your ID card, you should have received a new member welcome letter within days of your enrollment being completed. Your member identification and group number listed on your welcome letter can be used by the pharmacy to verify your benefits. You will need to pay your first premium payment before you can use your prescription benefits.


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I applied on the Health Insurance Marketplace, but haven't heard if my application has been received and accepted. Did my coverage start on the effective date I requested?

We receive new applications from the Marketplace every day. If you applied through the Marketplace, it will take a few days for processing through the Marketplace before they are sent to us. It then takes us about 5–10 business days to process your enrollment in the BCBSTX system.

If you just applied recently, we encourage you to wait to see if you receive your membership information soon. If you applied weeks ago and have not received anything from us, it is possible your application has been held up for some reason.

If you applied on the Health Insurance Marketplace or with BCBSTX online and you have not received information from us, call our Customer Service Center at 888-697-0683 and we will look up the status of your application. Our call volumes are still very high, so you may have to hold for a long period before getting through. We will help you as quickly as possible.


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When will I get my member ID cards, and how many will I get?

You should get your member ID cards in the mail soon after your application is approved. Individual plans will get 1 card and family plans will get 2 cards. Please note that all member ID cards will have only the subscriber name on it, but can be used by all of the dependents enrolled under the policy.

You can print a temporary ID card and request additional cards through your Blue Access for Members account. You will need your member identification number and group number to log in to Blue Access for Members. These numbers can be found on the new member welcome letter you will receive within days of enrolling.


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I received my ID cards in the mail but they only have my name on them and not my spouse's. Can I get another ID card with their name on it?

Your member ID cards will only have the primary subscriber's name on them, but they can be used by all of the dependents (in this case your spouse) enrolled under your policy.


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When will I get benefit coverage information and the contract on the plan I selected?

Within days of your application being accepted, you will receive a welcome letter from BCBSTX that includes your member identification number and group number. This information can be used by providers and pharmacies to verify your coverage until you get your member ID card. Your ID card will be sent separately soon after.

Your policy information is available through your Blue Access for Members account once your plan is in effect.


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I've gotten a call from someone asking me questions about my new coverage. Is this person with BCBSTX, and why are they asking these questions?

Since you have new coverage with us, we want to make sure you understand your benefits and that we have the information we need to help you with your health care needs. We are calling to:

  • Explain how your plan works
  • Answer questions you may have, and
  • Tell you about some of the services we offer to help manage your care and your coverage.

We also check to make sure the information we have is correct, such as the names of everyone on your plan, your address and other details.

The call often only takes about 15 to 20 minutes. If you have any concern that the person calling you is not with BCBSTX, ask the caller for a number you can use to call us back.


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When I try to register for Blue Access for Members, I get a message telling me it's not available. When will it be available for me to register?

You may have received this error message during your registration for a number of reasons. Many times, the information you entered may not have matched the data in our system. Please remember to have your group and member ID numbers handy when you register. Both of these numbers can be found on your welcome letter and your member ID card. Register now.


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I missed the open enrollment deadline. Can I still buy health insurance?

In most cases, you can only sign up for a health insurance plan during the open enrollment period. If you missed open enrollment, you may be able to enroll during the special enrollment period. To be eligible, you must have had a qualifying "life event" within the past 60 days or experienced other complications that did not allow you to complete your enrollment . Learn more about special enrollment.

If you don't qualify for the special enrollment period, you can still stay insured by buying short-term insurance directly from Blue Cross and Blue Shield of Texas (BCBSTX). We offer affordable short-term plans that can keep you covered until the next open enrollment period.

Please note: Short-term plans give you basic health care coverage, but they don't meet the Affordable Care Act's minimum essential coverage requirements. As a result, you may still have to pay a fine for having a plan that doesn't meet these requirements.


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I received a letter from you that tells me I can't keep my 2014 plan. When can I buy a new plan?

Some BCBSTX members learned that they can't keep their current insurance plan and must change to a new plan on January 1. These new plans meet the Affordable Care Act benefit requirements. If this applied to you, you can buy a new plan during Open Enrollment, which starts on November 15, 2014. Enroll by December 31 for coverage that starts on January 1, 2015. Log in now to view your plan options.


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I received a letter from Trover Solutions saying they have partnered with BCBSTX to investigate my medical claim. Should I respond to the letter?

BCBSTX and Trover Solutions have partnered to review the medical claim listed on your letter to determine if another person or insurance company should be responsible for the claim. The claim we are investigating may be for treatment you received from an injury experienced at work or from an auto accident.

The information we are requesting is important. It could help to get back money that should be paid by someone else, like another insurance carrier. This process is one of several tools used by BCBSTX to help control rising costs of health care. Call the number, 800-696-4573, on the letter to answer the claim question.


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What are my options to pay my premium?

  • Online — Make a one-time payment by bank draft through OrbiPay®*. Visit OrbiPay's secure website and follow the instructions to make your payment.
  • By mail — Pay your premium by mail with a personal check, cashier's check or money order. To do so, be sure you:
    • Make the check payable to Blue Cross and Blue Shield of Texas
    • Write your account/member ID number on your check, cashier's check or money order
    • Include the payment coupon that was sent to you with your premium invoice
    • Send your payment at least 5 business days in advance of the payment due date to ensure timely posting to your account
    • Make your payment to the address on your premium invoice
  • By personal check over the phone — Call the OrbiPay payment line toll-free at 877-433-3755. Please have your member ID number, bank routing number and bank account number ready. Your payment will be applied within 24 hours.
  • In person — Bring a copy of your premium invoice with your member ID number and "receive code," to any MoneyGram® location near you (including most Walmart, ACE Cash Express and CVS stores) and pay with cash. MoneyGram locations in Walmart stores also take debit card payments. Visit the MoneyGram website to find locations near you. Payments made in person will be applied to your account within 1-2 business days.
  • By debit or credit card — Pay by using a credit, debit or pre-paid debit card:
    • Call 866-654-8569 and enter the necessary information when prompted to make your payment. You will need your member ID number and group number. Both are included on your welcome letter and your member ID card.
    • Or log in to your Blue Access for Members account at bcbstx.com and look for the Billing & Payments section. Payments made with a card will be applied to your account within 1–2 business days.
  • By automatic recurring payments — Set up a recurring electronic funds transfer (EFT) by calling Customer Service at 888-697-0683. You will need your member ID number and group number, both of which can be found on your welcome letter and member ID card.

More information on all the ways you can pay your bill.


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BCBSTX drafted my bank account twice. When will I get my money back?

We sincerely apologize for our error in drafting your bank account twice for your premium payment. We had two active policies for you in our system, which pulled your records twice when the automated drafts were processed. We have corrected the error in our system, so this should not happen again. We will mail a refund check for the overpayment amount within 5 days of the error. If you don't see it soon, please give us a call. In addition, if you had overdraft fees as a result of the double billing, please contact us so we can refund these charges as well. You can reach us at 800-792-8595.


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I applied for a plan on the Health Insurance Marketplace and also applied for a plan directly with BCBSTX, so now I'm getting a bill for both. How do I cancel one?

We cannot process a cancellation request for a Marketplace plan. If you want to cancel your Marketplace plan, you can call the Marketplace at 800-318-2596. If you want to cancel our off-Marketplace plan, we can process that cancellation for you. Call Customer Service at 800-538-8833. You can also log in to your Blue Access for Members account and send us a secure email message.

A policy will also automatically be cancelled for nonpayment if you don't pay the premium. This may be your best option. You would simply pay the premium for the plan you want to keep and not pay the premium for the plan you want to cancel.

Members can log in to their Blue Access for Members account from a desktop or mobile browser for more information about benefits, claim status and more.


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What is an HMO? How is it different from other health care plans?

A Health Maintenance Organization (HMO) is a type of health plan that gives you access to certain doctors and hospitals who have contracted with the HMO, often called network providers. An HMO is different from other health care plans in a number of ways:

  • An HMO typically has a lower monthly premium and lower copayment levels than most other types of plans.
  • When you join an HMO, you select a primary care physician (PCP) who coordinates all your health care services.
  • Also, your HMO generally only covers health care services provided by the HMO's contracted network of health professionals and hospitals that together provide a full range of health care services. When choosing your HMO plan, make sure the doctors and hospitals you want to use are all in the HMO's network.

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How do I select a primary care physician (PCP)?

Use our Provider Finder® online directory to find the PCP in the HMO network who best fits your needs. Be sure the doctor you select is accepting new patients.

It's easy to use the Provider Finder by registering for Blue Access for MembersSM (BAM):

  1. Visit Blue Access for Members.
  2. Use the information on your BCBSTX member ID card to complete the registration process.
  3. Once you are registered, log in to BAM. The Provider Finder tool is located under the Doctors & Hospitals tab.
    Then,
  4. Know the name of your plan and choose it from the dropdown box "Select network type."
  5. Continue to search until you find a doctor who meets your needs and is accepting new patients.

TIPS:

  • Check your Benefit Booklet for your Network Type
  • Make sure you are searching within your network
  • Enter as much information as you know
  • Use filters to help narrow your search

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What happens if I don't select a PCP?

You must have a primary care physician assigned. If you don't select your own, we will assign one to you.


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How do I change my PCP?

You can call the Customer Service number on the back of your ID card to identify your new primary care physician (PCP) selection. You can also change your PCP by logging in to your Blue Access for Members account and clicking "Doctors and Hospitals." Before you change, make sure the PCP you are requesting is in your network and accepting new patients.


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Do I need a referral to see a specialist? How do I get a referral?

Your primary care physician (PCP) will provide you with a referral to a specialist if you need to see one. Always contact your PCP first for any care you need. However, women do not have to have a referral to see an OB/Gyn.


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Can I continue to see my current doctor when I join the HMO plan?

It is possible. Your doctor may already be in the HMO network you are considering. But if your doctor is not in the network you will need to select a new primary care physician (PCP).


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Do I have coverage if I am traveling?

In an emergency, go directly to the nearest hospital. For other needs, some HMO plans allow you to get health care services from a Blue Cross and Blue Shield affiliated doctor or hospital when you are traveling outside of Texas. If you aren't sure, contact customer service at the number on the back of your member ID card before you go. And always remember to carry your current BCBSTX member ID card. It contains helpful information for accessing health care at home or away.


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What if I'll be away for more than 90 consecutive days?

If you or a covered family member will be temporarily living outside of Texas for 90 days or more, you may be eligible for guest membership in a Blue Cross and Blue Shield-affiliated HMO. In some circumstances, moving can also qualify you to be able to enroll in a new plan in your new location. You can call the customer service number on the back of your ID card to find out if your plan covers you when living outside Texas and to discuss your options.


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What if I'm already in treatment when I enroll and my doctor isn't in the network?

We'll work with you to provide coverage for the most appropriate care for your medical situation, especially if you are pregnant or receiving treatment for a serious illness. You may still be able to see your current provider for a brief time. Call us at the Customer Service number on the back of your BCBSTX ID card for more information.


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How do I work with my primary care physician if I have a chronic or pre-existing condition?

When you join an HMO your doctor, known as a primary care physician (PCP), coordinates all your care, including referrals to specialists if needed. If you are already seeing a specialist for your condition, make sure that specialist is in your plan's network. If the specialist is not in your plan's network, in most cases you will pay more. You will still need a referral from your PCP to see a specialist.

  • Step 1 — Discuss your medical conditions or concerns with your PCP.
  • Step 2 — Your PCP will refer you to a specialist in your plan's network and send your information to the specialist. Make sure that the specialist you are referred to is in your network. Just call customer service at the number on the back of your BCBSTX ID card before your first office visit.
  • Step 3 – Call the specialist's office to make an appointment.

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Does my plan cover prescriptions?

Your BCBSTX HMO benefits also cover prescription drugs. Not all drugs are covered. You can visit our website to view the list of prescriptions your plan covers. This list is called a preferred drug list. To look for your medicines, you will need to know:

  • The medicine's exact name
  • The dose you take
  • How many pills your doctor often prescribes for you

While costs can vary depending on your benefit plan, you usually pay less for generic drugs and more for brand name drugs. Your plan may cover some of the costs of drugs not on your preferred drug list. You can learn more by looking in your benefit book, or calling the customer service number on the back of your ID card.


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* BCBSTX has contracted with a third-party vendor, Alacriti Payments, LLC, to process your ACH/electronic check payment. In order to process this payment, you will be redirected to Alacriti's secure payment site, OrbiPay. If you have any problems with your payment, please contact BCBSTX customer service at 800-538-8833.