The provider network that is available to you under the terms of your plan is made up of independently contracted doctors, hospitals and other health care providers. The contracted providers in your network do not work for or are part of BCBSNM. However, they do have agreements with BCBSNM that may help save you money for covered services.
Your costs will vary depending on whether your provider is participating in the network. Please refer to Provider Finder® to find in-network providers. You should check if your plan has out-of-network benefit coverage before scheduling a visit.
Your Network and Your Plan Type
The way you use the provider network available under your health plan may vary by your plan type. The following is a brief description of how each plan type works.
Health Maintenance Organization (HMO)
If you have an HMO, you must work with a contracted (in-network) primary care physician (PCP) to help coordinate any care you receive within your provider network. When you first sign up for an HMO, you choose, or are assigned, a PCP.
Your PCP is your partner to help guide you with your health care needs. When using your HMO plan, keep in mind the following:
- You must work with your PCP whenever you need care. When you first choose or are assigned a PCP, schedule a visit as soon as possible. Going right away will help avoid delays later when you are sick or need a referral.
- You must see in-network providers. For non-emergency care, HMO members must stay in network to receive benefits, except in limited circumstances as stated in your policy. Otherwise, you will be responsible for paying the entire cost of an out-of-network provider visit. To ensure you stay in network, consult with your PCP. If you want to select a new PCP, search Provider Finder® before visiting a new doctor or health care facility to make sure that the PCP is in your network.
Participating Provider Option (PPO)
Under your PPO plan, there is a network of independently contracted health care providers you can use when you need care. When using your PPO plan, keep the following in mind:
- You don't have to choose a PCP. Unlike with HMOs, PPO members aren't required to select a primary care physician (PCP) to coordinate care.
- You don't need a referral to see a specialist. You don't need a referral to see a specialist or behavioral health care provider. You also don't need a referral to visit a hospital. If your doctor refers you to a specialist, you will still want to verify that the provider is in your network.
- You can receive out-of-network care. While HMO members must generally stay in their network, PPO members can receive services from out-of-network providers. However, you will usually pay more for your services out-of-pocket if you see an out of network provider.
To make sure a provider is in your plan's network, search Provider Finder before visiting a new doctor or health care facility.