Out-of-Network Coverage

In most cases, you must receive your care from a CHIP in-network plan provider. If no one in the network can give you the care you need, your primary care provider (PCP) will get an OK from us to send you to a provider that is not in the network. You do not need an OK from us or need to be referred by your PCP to see a family planning care provider.

There are some exceptions when care you receive from an out-of-network provider will be covered. Those exceptions are:

  • Emergency care
  • Doctor care for a mother and her newborn for at least 48 hours after a vaginal delivery and 96 hours after a cesarean section

Emergency Care

In an emergency, you should get help for your child right away. You do not need a referral. Call 911 or go to the nearest emergency room for medical care. You or your child will be seen as soon as possible. Your child will be covered for emergency services even if the provider is not part of the Blue Cross and Blue Shield of Texas network.

If you get non-emergency care from a provider that is not in the network before you get the required OK from us, you may have to pay for the service.

Out-of- Area Care

If you/your child needs medical care when traveling, call us toll-free at 1-888-657-6061 (TTY 711) and we will help you find a doctor.

If you/your child needs emergency services while traveling, go to a nearby hospital. After you are seen then call us toll-free at 1-888-657-6061 (TTY711) to tell us that you were seen.

Urgent Care

An urgent medical condition is not an emergency but needs medical care within 24 hours. This is not the same as a true emergency. Call your child's PCP if your child's condition is urgent and he or she needs medical care within 24 hours.

If your child is away from home and needs urgent care, call one of these right away:

  • Your child's PCP
  • Blue Cross and Blue Shield of Texas (BCBSTX) Customer Advocate Department at 1-888-657-6061. Members with hearing or speech loss may call our TTY line at 711.
  • 24-Hour Nurse Advice Line, your 24-hour nurse help line at 1-844-971-8906 (TTY 711).

For more information, Contact Us or view the Member Handbook.

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