How the Plan Works
In-Network vs. Out-of-Network Providers
You have the freedom to choose your own doctor at the point of service. No primary care physician (PCP) or referrals required.
- With in-network providers:
- Receive highest level of benefits
- No claims to file in most cases (network provider will usually file the claims)
- No balance billing; network providers cannot bill for costs exceeding the allowed amount.
- With out-of-network providers:
- Receive out-of-network level of benefits (reduced level from network)
- May have to file own claims
- May be billed for charges exceeding the allowed amount
Even if you visit a non-network doctor, you may still save money. Blue Cross and Blue Shield of Texas (BCBSTX) contracts with many out-of-network doctors and hospitals, called ParPlan providers. When using a ParPlan provider, you will receive the out-of-network level of benefits. However, Parplan providers accept the BCBSTX allowed amount. In most cases ParPlan providers will file claims, too.