In most cases, you must receive your care from a STAR 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. For emergency or urgent care, you do not need to get an OK from us. You also do not need an OK from us or need to be referred by your PCP to see a family planning care provider.
Emergency Medical Care
You do not need approval from us or your PCP during an emergency. Instead, call 911 or go to the nearest ER for emergency medical care. It does not matter if you are inside or outside our service area. You will be covered for emergency services in the U.S. even if the emergency services provider is not part of the Blue Cross and Blue Shield of Texas (BCBSTX) network.
A person should go to the emergency room if he or she:
- May die.
- Has chest pains.
- Cannot breathe or is choking.
- Has passed out or is having a seizure.
- Is sick from poison or a drug overdose.
- Has a broken bone.
- Is bleeding a lot.
- Has been attacked.
- Is about to deliver a baby.
- Has a serious injury to the arm, leg, hand, foot or head.
- Has a severe burn.
- Has a severe allergic reaction.
- Has an animal bite.
- Has trouble controlling behavior and, without treatment, is dangerous to himself/ herself or others.
If you are outside of the BCBSTX service area and need care that is not an emergency, call one of these right away:
- Your PCP (the name and phone number are on your BCBSTX ID card)
- Toll-free BCBSTX Customer Advocate Department number at 1-888-657-6061 or TTY 711.
- Nurse Advice Line number at 1-844-971-8906 (TTY 711)
Do not use the emergency room (ER) for routine care. If you do so, you will have to pay for those services. We do not cover ER visits for routine care.
For more information, contact customer service or view the STAR Member Handbook.