An HMO is a type of health plan that often has lower monthly premiums and out-of-pocket costs, like copayments and deductibles. HMOs only cover health care services given by a certain group of doctors and hospitals, called a provider network. Not all HMO plans are the same. Some HMOs may have a smaller provider network and lower monthly premiums than other HMOs.
Things to Know About HMOs
- See your primary care physician (PCP) first. Your PCP directs your health care.
- Get a referral. Before you visit a specialist, get a referal from your PCP. Be sure the specialist is in your network. You do not need a referral from your PCP to see your in-network OB/Gyn.
- Stay in network. If you visit a doctor or a hospital that is not in your network, you will be respnsible for the full cost of your care, in most cases. Check Provider Finder® to make sure your doctors, specialists and hospitals are in your plan's network.
- In an emergency — when your injury or illness is serious or life-threatening go to the nearest emergency room. You don't need a referral.
- Know where to go. Before you go for care, make sure you know how your plan works, what’s covered and where to go. It may save you time and money. Learn More
About Your Primary Care Physician (PCP)
When you first sign up for an HMO, you choose — or are assigned — a primary care physician (PCP). These doctors focus on general practice, internal medicine and family practice. An obstetrician-gynecologist can serve as a woman's PCP. A pediatrician can serve as a child's PCP.
- Find your PCP on the front of your BCBSNM member ID card or in Blue Access for MembersSM, our secure member website.
- You don't need a referral to see a doctor for a specific issue, as long as he or she is in your HMO plan's network. Check Provider Finder to make sure they are in-network.
- If you're a new patient, see your PCP as soon as possible. Tell him or her you're a new patient when you call to make your first appointment. This will help avoid delays when you are sick or need a referral.
- You can change your PCP online or by phone.
- Log in to Blue Access for Members
- Select the Doctors & Hospitals tab
- Select the Change PCP link
- Follow the instructions
Call the Customer Service number on the back of your BCBSNM member ID card.