Exclusive Provider Organization (EPO)

Blue Cross and Blue Shield of Texas (BCBSTX) offers self-funded clients with more than 500 employees EPO plans. EPO managed health care plans provide for the payment of benefits only when the member utilizes providers in the BlueChoice Network. These network providers, including physicians, specialty care providers, hospitals, and other health care facilities and practitioners, have contracted with BCBSTX to provide health care services at negotiated rates.

When care is received from Network providers:

  • Network Benefits are available 
  • Members are not required to file claim forms – network providers bill BCBSTX for services provided 
  • Members are not balance billed – network providers will not bill for costs that are in excess of the BCBSTX allowable amount for covered services. 
  • Network providers are responsible for any necessary prior authorization 

When care is received from providers that are not network providers:

  • No benefits are available under the plan 
  • Members are responsible for the full amount billed by the provider 

BlueChoice Network

BCBSTX EPO plans are available to clients through the BlueChoice Network, one of the largest networks in Texas. BlueChoice provides:

  • Access to the national BlueCard® network when members are outside of Texas 
  • Over 600 participating hospitals and facilities in Texas 
  • More than 800,000 doctors and 6,000 hospitals contracting with Blue Cross and Blue Shield plans nationwide 

For health care services required outside of Texas, members have access to the BlueCard national network of providers.

BCBSTX can provide a variety of EPO managed health care plans for your large, self-funded clients customized to fit their needs.

For more detailed information on available benefit designs, a description of the services and supplies that are covered, a listing of those services and supplies that are limited or excluded, terms and general administration, or for any questions you may have regarding our products and services, visit the Contact Us page for the number of the regional sales office near you.