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Easy Access to BlueCard PPO Providers
By linking individual preferred provider organization (PPO) networks of Blue Cross and Blue Shield Association (BCBSA), the BlueCard PPO provides you with access to one of the largest health care networks in America.
As a participant of the BlueCard PPO, you will receive the in-network benefits while receiving medical care from contracting network providers outside of Texas. Although the contracting network providers may precertify those services that require precertification, it is ultimately your responsibility to obtain precertification by calling the appropriate number on the back of your ID card. BlueCare PPO contracting providers have agreed to accept the Blue Cross and Blue Shield of Texas (BCBSTX) allowable amount and not balance bill you.
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Your Card is Recognized Across the United States
Your BCBSTX ID card – "The BlueCard" – gives you access to BCBSA network providers throughout the United States. The PPO-in-a-suitcase logo tells providers that you are part of the BlueCard PPO. The three-letter alpha prefix that precedes your subscriber number on your ID card identifies BCBSTX as your service area.
Usually No Paperwork or Claims to File
BlueCard PPO contracting providers have also agreed to file your claims. When visiting a PPO provider, all you need to do is show your ID card. You will be responsible for any applicable copayment or deductible, and coinsurance amounts, in addition to any services that are not covered or not approved by BCBSTX. The physician will then file your claim with the local BCBSA insurance plan with which he or she is a contracting PPO provider. When your provider submits your claim, it is important that the three-letter alpha prefix from your ID card is included. This prefix is the key to timely and accurate claims processing.
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Choosing a BlueCard PPO Contracting Provider
To get the most out of your BlueCard PPO, always use a PPO contracting provider. Simply call Customer Service or the BlueCard PPO line at 1-800-810-BLUE (2583). The representatives can help you verify a BlueCard PPO provider or help you locate one near you. If you have a provider in mind, you can also verify that the provider participates in the local BCBSA PPO program.
Visiting a BlueCard PPO Contracting Provider
When you visit a PPO provider, simply present your ID card and remind the provider that you are a BlueCard PPO member. Once services are rendered, the provider will file your claim with the local BCBSA insurance plan with which he or she contracts.
Most providers already understand their roles and responsibilities regarding the BlueCard PPO. But in case your provider has questions, please tear out the information checklist prior to this page (entitled How BlueCard PPO Works) and keep it with your ID card. This checklist is designed to help answer questions the provider may have regarding the BlueCard PPO.
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