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Make Your Insurance Work for You

Get to Know How Your Health Plan Works

Take full advantage of your health insurance benefits with these helpful tips.

  • Stay in the network. Most health plans, like HMOs and PPOs, use certain groups of doctors, hospitals and other health care professionals called provider networks. If you visit a doctor outside of your network, you may have to pay more for your care. In some cases, you may have to pay the full cost. For HMOs, if you are referred to a specialist, make sure he or she is in your network.
  • Know what's covered. Make sure services or treatments are covered before you schedule them. If you have a PPO, you may need pre-authorization (pre-notification) from Blue Cross and Blue Shield of Texas (BCBSTX) before you get certain tests or services. You or your doctor must call the pre-authorization (or pre-certification) number on the back of your member ID card to confirm.
  • Understand health insurance costs. Heath insurance costs can be confusing. Knowing what premiums, deductibles, coinsurance, copayments and out-of-pocket maximums are and how they all work together can help you understand how your plan works.
  • Conduct an "annual check-up" of your health plan. Make sure your plan still meets your needs. This is especially true if you've had a major life event like a birth, death, marriage or divorce.

Where You Go Matters

It's important to know where to go when you need medical care. Sometimes it's clear and at other times, it's not so clear. While the answer is not always simple, knowing the difference and deciding where to go can mean the difference in costs and time. The main thing is to be prepared before you go and make sure ahead of time you will be covered by your plan's network.

Use the Health Care Options chart below to help you decide where to go based on your health care need:

Health Care Options

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Average
Costs
Average Wait
Times
Examples of
Health Issues
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24/7 Nurseline Icon

24/7 Nurseline

Around the clock care 24 hours a day, 7 days a week.

Cent Sign Image

 

Single Clock image

17 seconds*

Registered nurses are on call to answer your health questions, 24 hours a day, seven days a week

Click to play the video
Doctor icon

Your Doctor

Your first choice for non-emergency care

Dollar Sign Image

 

Single Clock image

24 minutes*

  • Cuts and scrapes
  • Fever, colds and flu
  • Minor burns
  • Ear or sinus pain
  • Shots
  • Eye swelling, pain
  • Sore throat
  • Stomach ache
  • Physicals
  • Minor allergic reactions
Click to play the video
Retail Clinic Icon

Retail Clinics

For care when you can’t see your doctor

Dollar Sign Image

 

Single Clock image

15 minutes

  • Infections
  • Minor injuries or pain
  • Flu Shots
  • Skin problems
  • Bronchitis
  • Cold and flu
  • Shots
  • Sore and strep throat
  • Allergies
Click to play the video
Urgent Care icon

Urgent Care

When it’s not a true emergency, but needs immediate attention

4 Dollar Signs Image

 

Single Clock image

11-20 minutes**

  • Migraines or headaches
  • Urinary tract infection
  • Back pain
  • Cuts that need stitches
  • Sprains or strains
  • Animal bites
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Emergency Room icon

Emergency Room

For life-threatening problems

6 Dollar Signs Image

 

4 Clocks image

4 hours, 7 minutes

  • Chest pain, stroke
  • Head or neck injuries
  • Heart attack
  • Fainting, dizziness, weakness
  • Problems breathing
  • Seizures
  • Sudden or severe pain
  • Severe vomiting, diarrhea
  • Uncontrolled bleeding
  • Broken bones
Click to play the video

* Medical Practice Pulse Report 2009, Press Ganey Associates

** Urgent Care Benchmarking Study Results. Journal of Urgent Care Medicine. January 2012.

† Emergency Department Pulse Report 2010 Patient Perspectives on American Health Care. Press Ganey Associates. http://www.pressganey.com/Documents_secure/Pulse%20Reports/2010_ED_Pulse_Report.pdf?viewFile (Accessed February 2014).


 

Key points to remember:

  • 24/7 Nurseline. You have access to our 24/7 Nurseline at 1-800-581-0393. Registered nurses can answer your general health questions and help you decide if you need care and where you should go. Be sure to have your member ID card ready before you call.

    When Martha's newborn was sick over the weekend, instead of going to the emergency room, she called the 24/7 Nurseline. Watch Now Play the Video icon

  • Use the ER for emergencies only. When your injury or illness is serious, call 911 or go to the nearest emergency room. You don't need a referral. If it's not an emergency, you may be able to save money by seeing your regular doctor for colds, minor sprains and other less serious conditions.
  • You're covered away from home. Always carry your member ID card with you at all times, especially when you’re traveling. If you have a life threatening injury or illness when you're traveling, go to the nearest hospital. You don't have to find a network doctor to be treated and you don't need a referral. If you have questions before getting care, call BCBSTX at 1-888-697-0683.

    Care Away From Home: Watch Now Play the Video icon

Use Your Blue Access for Members Tools and Perks

Blue Cross and Blue Shield of Texas members can access Blue Access for MembersSM, our secure member website, where you can:

  • Manage your account online
  • Check the status of claims and set-up email alerts
  • Order a new member ID card and print a temporary card
  • Start a free program to help you lose weight or stop smoking
  • Search and compare doctors, hospitals and dentists

Register or log in to Blue Access for Members.

Keep a Medical History

A medical history can be anything related to your health. It can be as basic as a list of medications, illnesses and doctor's visits, or be much more detailed. Keeping track of your health history and your family's will help you to:

  • Work with your doctor to keep healthy or diagnose a condition
  • Avoid drugs that may be harmful due to allergies
  • Make it easier and faster to fill out an application for individual insurance, file an insurance claim, an appeal on a claims decision, or dispute billing errors
  • Make it easier to track expenses in Flexible Spending Accounts or Health Savings Accounts

What to Track in Your Medical History

At the very least, you should track:

  • Illnesses and injuries, including dates, doctor's visits and symptoms
  • Treatments and therapies you've had, and if they helped or not
  • Prescription drugs you've taken, including results and side effects
  • Health screenings and results
  • Current weight
  • Allergies, including drug allergies

You may also want to track:

  • Blood pressure
  • Cholesterol levels
  • Changes in habits, weight, energy level or bodily functions

Learn more on Connect

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24/7 Nurseline

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Your Doctor

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Retail Clinics

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Urgent Care

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Emergency Room

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Member Voice: Martha

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Care Away From Home

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