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 select 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 all of your health care.
- You don't need a referral for a specialist. Your PCP can give you a referral or you can find a specialist on your own.
- Stay in network. Check Provider Finder® to make sure your doctors, specialists and hospitals are in your plan's network to avoid paying out-of-network costs.
- 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.
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 obstetrics-gynecology doctor can serve as a woman's PCP. A pediatrics doctor 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.