An HMO is a type of health plan that often has lower monthly premiums and out-of-pocket costs, like copayments and deductibles. HMOs only cover health care services given by a certain group of doctors and hospitals, called a provider network. Not all HMO plans are the same. Some HMOs may have a smaller provider network and lower monthly premiums than other HMOs.
Things to Know About HMOs
- See your primary care physician (PCP) first. Your PCP directs your health care.
- Get a referral. Before you visit a specialist, get a referral from your PCP. Be sure the specialist is in your network. You do not need a referral from your PCP to see your in-network OB/Gyn.
- Stay in network. Check Provider Finder® to make sure your doctors, specialists and hospitals are in your plan's network to avoid paying out-of-network costs.
- In an emergency — when your injury or illness is serious or life-threatening go to the nearest emergency room. You don't need a referral.
About Your Primary Care Physician (PCP)
When you first sign up for an HMO, you choose, or are assigned, a primary care physician (PCP). These doctors and medical professionals focus on general practice, internal medicine and family practice. An obstetrician-gynecologist can serve as a woman's PCP. A pediatrician can serve as a child's PCP.
- Find your PCP on the front of your BCBSTX member ID card or in Blue Access for MembersSM, our secure member website.
- If you're a new patient, see your PCP as soon as possible. Tell him or her you're a new patient when you call to make your first appointment. This will help avoid delays when you are sick or need a referral.
- You can change your PCP online or by phone.
- Log in to Blue Access for Members
- Select the Doctors & Hospitals tab
- Select the Change PCP link
- Follow the instructions
Call the Customer Service number on the back of your BCBSTX member ID card.