Doctors and Hospitals
Your Providers
Blue Cross Group Medicare Advantage Open Access (PPO)(MPO)
If you enroll in the Open Access (PPO) plan, you are not required to use a network provider for coverage. Your benefit levels are the same if you use a Blue Cross and Blue Shield network or non-network provider. You may seek care from any provider nationwide who is willing to see you as a patient, accepts Medicare and agrees to submit claims to BCBSTX.
This Your Providers, Your Personal Network flyer further explains Open Access coverage for you and your provider.
Please note: Nearly 98% of providers nationwide accept Medicare assignment, but there are providers who do not accept Medicare or have “opted out.” A Blue Cross Group Medicare Advantage Open Access (PPO) member may have lower out-of-pocket costs if he or she receives care from a provider who accepts Medicare assignment rather than one who does not, or who has opted out.
Medicare-assigned providers can decide what patients they want to see. We recommend that you confirm with providers that they will accept your Open Access (PPO) plan and file claims with us directly.
Blue Cross Group Medicare Advantage (HMO)(PMA)
If you enroll in the HMO plan, you must reside in the state of Texas. You are required to select a primary care provider (PCP) to coordinate your care. The HMO has a network of doctors, hospitals, pharmacies and other providers. If you use providers that are not in the network, the plan may not pay for those services. Visit Provider Finder® to find a participating provider. Referrals are required to see a specialist.
Some high-cost medical services have more cost-effective alternatives that require prior authorization from the plan before your provider can proceed.
Provider Finder®
Our Provider Finder offers you more ways to search than ever before. You can still look up doctors, hospitals and other providers by location. But now you can also research providers using patient reviews, and quality, certification and recognition information.
Do a quick Open Access PPO search or HMO search now, or log in to Blue Access for Members to:
- Find providers wherever you are without entering your location for each search.
- Find all locations where a provider practices in one search.
- Use a global search bar to get faster results.
- See if a Blue Distinction® Center for Specialty Care is available near you.
- See what other patients say about a provider, or add your own review.
- View quality, certifications and recognitions for doctors.
Find a Provider while Traveling Internationally
The Blue Cross and Blue Shield Global Core program gives members traveling outside of the United States and its territories access to urgent and emergency medical assistance services and doctors and hospitals in more than 200 countries around the world. If you have questions about what medical care is covered when you travel, please call Customer Service or access information at www.bcbsglobalcore.com.
IMPORTANT: NEW MEMBER NUMBER
As a Medicare Advantage member, you have a new member number and ID card. Be sure to show your new card to your providers or their office staff. Remind them that your old ID is no longer valid. If the provider does not use your new number, your benefits cannot be confirmed and there may be delays in care and in processing your claims.