Find a Provider

You should use in-network providers. These providers are contracted with BCBSTX to provide medical care to members.

If you choose to go to a doctor who is not part of our network, you may have to pay for the services. Except in an emergency, the plan may not cover care that you get from an out-of-network provider. Check with the provider to make sure they are in the network before you get care. Check Out-of-Network Coverage to learn more.

Our network continues to grow. If you do not find a provider you are looking for, call the BCBSTX Customer Advocate Department phone number for your plan.

Keep in mind you may need to get approval for some services before you are treated. This is called "prior authorization." BCBSTX may not cover the service if you don't get approval.

You don’t need approval for:

• Emergency care
• A medically necessary service from an in-network provider

Also, you do not need a referral to get emergency services. You should call your PCP after the emergency so follow-up care can be planned. This should be done for any emergency at home or away.

You must choose a PCP from the provider network when you join.* You can choose a different PCP for each member. A PCP is your main health care provider and will arrange your care with other doctors and hospitals. Your PCP can be a:

• Pediatrician
• Family or General Practitioner
• Obstetrician/Gynecologist (OB/GYN)
• Internist (Internal Medicine)
• Nurse Practitioner (NP) or Physician Assistant (PA)
• Clinic such as Federally Qualified Health Centers (FQHCs) or Rural Health Clinics (RHCs)

Do you need help finding a PCP or changing your current PCP? 

You can:

• Log in to Blue Access for Members℠ to do this. After logging in, go to My Health > Find Care. Then, choose to Select a Provider or Change Provider.
  
• Call the Customer Advocate Department for your plan to get help finding or choosing a PCP. 
  • CHIP and STAR: 1-888-657-6061 (TTY: 711)
  • STAR Kids: 1-877-688-1811 (TTY: 711)

Note: If you do not choose a PCP when you join your plan, one will be assigned to you. 

*CHIP Perinate plan members are not required to pick a PCP.

To find out if BCBSTX covers counseling referral services based on moral or religious objections, you should call the Customer Advocate Department. If you disagree with the outcome, you can file an appeal. Check Complaints and Appeals to learn more. For questions, please call the Customer Advocate Department for your plan.

BCBSTX allows members with special health care needs to have direct access to the right specialists for their conditions and identified needs. This includes a standing referral to a specialty doctor or having a specialist as a PCP if needed.

You don’t need to get approval or a referral from your PCP for:

• Mental Health/Substance Use services.
• Emergency services. You should call your PCP after the emergency so follow-up care can be planned. This should be done for any emergency at home or away.
• Help with family planning. Some PCPs and OB/GYNs offer family planning. Members may use any qualified family planning clinic, certified nurse midwife or provider. The provider does not need to be part of BCBSTX.

If you need help finding a specialty doctor, mental health/substance use services or an OB/GYN provider, call the Customer Advocate Department for your plan.

ABA therapy is a benefit for STAR and STAR Kids members as a covered benefit through Texas Medicaid. ABA can help children with Autism Spectrum Disorder (ASD). With ADA, members can develop improved function with their peers and caregivers. To qualify for ABA, your child must first have special testing to confirm their diagnosis of ASD.

ABA testing is more thorough than what most pediatricians can do as part of their practice. The testing must be performed by a specialist such as a developmental pediatrician, a neurologist, a psychiatrist, a licensed psychologist, or an Autism diagnosis team. Speak to your child’s pediatrician to get a referral to one of these specialist.

Please check the ABA therapy Frequently Asked Questions for more information.

Go to the Provider Finder^® for your plan below to search for and print a list of ABA providers in your area.

• Search STAR Provider Finder
• Search STAR Kids Provider Finder

Do you have more questions about ABA services? Please call the BCBSTX Service Coordination phone number for your plan:

• STAR: 1-877-214-5630 (TTY: 711)
• STAR Kids: 1-877-301-4394 (TTYY: 711)