Your Questions – Members with Blue Advantage HMO℠ 

As an HMO member, you must seek in-network care for your benefits to apply, except in emergencies. 

 In the case of a life-threatening illness or injury, go to the nearest emergency facility right away. Emergency services are covered at your in-network benefit level. Your responsibility for any additional charges will depend on your health plan and applicable law. Learn about surprise billing  at bcbstx.com.

As an HMO member, you must seek in-network care for your benefits to apply, except in emergencies. However, many doctors who participate in Blue Advantage HMO have privileges at other hospitals, or they can apply for privileges at other in-network hospitals. We encourage you to talk with your doctors about your care options.

You will continue to have in-network access to SWHR through the remainder of 2025. For 2026, you have two options:

1. Select a new PCP who is not affiliated with SWHR, or
2. Select another plan option during open enrollment to maintain an in-network relationship with these providers.

You can log in to or sign up for your member account online or through the BCBSTX App to find additional provider options and change your PCP. 

You can change your PCP selection at any time. Review your options for in-network care at bcbstx.com and select Find Care. To change your PCP, log in your member account online or through the BCBSTX App to make the switch. 

You have many choices for quality, cost-effective care:

• Visit bcbstx.com and select Find Care, or visit your online provider directory
• Log in to or sign up for your member account online or through the BCBSTX App
• Call the number on your member ID card  

When scheduling future procedures for members with Blue Advantage HMO, we’ll let doctors know of the contract expiration and work with them to avoid disrupting your care. If needed, we’ll help them transition your care or schedule procedures with other in-network doctors, hospitals or facilities.

Yes. In the case of a life-threatening illness or injury, go to the nearest emergency facility right away. Emergency services are covered at your in-network benefit level. Your responsibility for any additional charges will depend on your health plan and applicable law.

Members with a Blue Advantage HMO plan will continue to have in-network access to SWHR through the remainder of 2025.

As of Jan. 1, 2026, if you are pregnant or being treated for a disability, acute condition or life-threatening illness, you may qualify as a continuity-of-care patient. This means you may still be able to receive care at SWHR at in-network rates even after it is no longer in the Blue Advantage HMO network.

If you are eligible for continuity of care, you will not be balance billed or have to pay more than the amount covered by your plan, even if SWHR charges more.

If you have questions, call the customer service number on your member ID card. Customer Advocates will help answer questions about your specific benefits and provide guidance. Your doctor may also start the continuity-of-care process by calling the prior authorization number on your member ID card.

BCBSTX members: You may start the process by completing a Request for Continued Access to Providers form or by calling the number on your member ID card. Forms should be faxed to the number on the form. Once reviewed, you and/or your doctor may be contacted for more information, like medical records. A decision will be made and shared with you or your doctor, most often in less than a week.

View the list of facilities and provider groups that will no longer be in our Blue Advantage HMO network as of Jan. 1, 2026.

If you have a procedure scheduled at an SWHR facility on or after Jan. 1, 2026, please call the number on your member ID card to ask about your benefit coverage.

If you have a procedure performed before Jan. 1, 2026, and your hospital stay goes past Jan. 1, 2026, your care may be covered at the in-network level. We’ll work closely with SWHR facilities to avoid issues with your bill, so you can focus on getting better.