What is a copayment (copay)?
A copay is the amount paid at the time of service for certain medical services and prescription drugs. With HMO Blue Texas, the only amount you'll pay for covered services is your copayment. There are no deductibles, and you shouldn't receive any bills after your visit.
Will I need to see my PCP for all of my health care needs?
In most cases, yes. Your PCP will provide or coordinate all of your covered health care. If you need specialty care, your PCP will refer you to a specialist who is part of your PCP's network of health care professionals.
Will I be able to see an OB/GYN without a referral?
Yes. You will have direct access to OB/GYNs in the HMO Blue Texas network. However, you will need to see an OB/GYN in the same limited network as your PCP.
What if I'm receiving treatment from an out-of-network doctor now?
If you're pregnant or require ongoing care for a serious illness when you enroll, and your doctor isn't in the HMO Blue Texas network, you may be able to continue seeing that doctor while you transition care. Call HMO Blue Texas Customer Service toll-free for details: 1-888-322-2379.
What will I need to do in case of an emergency?
Call 911 or seek help from any doctor or hospital immediately. You, your doctor, a hospital or a family member should then call your PCP within 48 hours of the emergency visit or as soon as possible.
What if I need non-emergency medical care when I'm out of town?
If you need urgent care (care that can't wait until you return home), you can receive covered care from Blue Cross and Blue Shield contracting providers nationwide through the BlueCard Program. If you'll be outside of Texas for more than 90 days, you may be eligible for guest membership in a Blue Cross and Blue Shield-affiliated HMO.
