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Get Answers to Our Most Frequently Asked Questions

I have a question about membership.

I have a question about buying health insurance.

I have a question about updating my health plan account.

I have a question about payments.

I have a question about my HMO.

How can I learn more about my benefits?

You can log in to Blue Access for Members 24/7 to access your benefits information or Call the Customer Service number on the back of your BCBSTX ID card.


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Are my medical records kept private?

Yes. We are committed to protecting your medical records, and have strict rules to make sure our staff and anyone who needs to see your records keep all your member information confidential. Your medical records or claims details may have to be reviewed. If so, precautions are taken to keep your information safe. In many cases your identity, such as name and address, will not be included in the information provided during the review.


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Has my coverage started? Can I use my health plan?

Your first premium payment activates your coverage, so you can start using your health plan within 1–2 days of making your payment, depending on how you pay.

After you've made your first payment and your coverage is activated, you can have health care expenses during that coverage gap applied to your deductible, or even get paid back for some services. In this case, the coverage gap would be the time between your requested effective date and the date you make your first payment.


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I need to get a prescription filled but don't have my ID card yet. What can I do?

Even if you haven't received your ID card, you should have received a new member welcome letter within days of your enrollment being completed. Your member identification and group number listed on your welcome letter can be used by the pharmacy to verify your benefits. You will need to pay your first premium payment before you can use your prescription benefits.


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I applied on the Health Insurance Marketplace, but haven't heard if my application has been received and accepted. Did my coverage start on the effective date I requested?

We receive new applications from the Marketplace every day. If you applied through the Marketplace, it will take a few days for processing through the Marketplace before they are sent to us. It then takes us about 5–10 business days to process your enrollment in the BCBSTX system.

If you just applied recently, we encourage you to wait to see if you receive your membership information soon. If you applied weeks ago and have not received anything from us, it is possible your application has been held up for some reason.

If you applied on the Health Insurance Marketplace or with BCBSTX online and you have not received information from us, call our Customer Service Center at 888-697-0683 and we will look up the status of your application. Our call volumes are still very high, so you may have to hold for a long period before getting through. We will help you as quickly as possible.


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When will I get my member ID cards, and how many will I get?

You should get your member ID cards in the mail soon after your application is approved. Individual and family PPO members will receive no more than 2 membership ID cards. Please note that all member ID cards will have only the subscriber name on it, but can be used by all of the dependents enrolled under the policy. HMO Individual and family plans will get a card for each member enrolled.

You can print a temporary ID card and request additional cards through your Blue Access for Members account. You will need your member identification number and group number to log in to Blue Access for Members. These numbers can be found on the new member welcome letter you will receive within days of enrolling.


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I received my ID cards in the mail but they only have my name on them and not my spouse's. Can I get another ID card with their name on it?

Your member ID cards will only have the primary subscriber's name on them, but they can be used by all of the dependents (in this case your spouse) enrolled under your policy.


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When will I get benefit coverage information and the contract on the plan I selected?

Within days of your application being accepted, you will receive a welcome letter from BCBSTX that includes your member identification number and group number. This information can be used by providers and pharmacies to verify your coverage until you get your member ID card. Your ID card will be sent separately soon after.

Your policy information is available through your Blue Access for Members account once your plan is in effect.


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I've gotten a call from someone asking me questions about my new coverage. Is this person with BCBSTX, and why are they asking these questions?

Since you have new coverage with us, we want to make sure you understand your benefits and that we have the information we need to help you with your health care needs. We are calling to:

  • Explain how your plan works
  • Answer questions you may have, and
  • Tell you about some of the services we offer to help manage your care and your coverage.

We also check to make sure the information we have is correct, such as the names of everyone on your plan, your address and other details.

The call often only takes about 15 to 20 minutes. If you have any concern that the person calling you is not with BCBSTX, ask the caller for a number you can use to call us back.


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When I try to register for Blue Access for Members, I get a message telling me it's not available. When will it be available for me to register?

You may have received this error message during your registration for a number of reasons. Many times, the information you entered may not have matched the data in our system. Please remember to have your group and member ID numbers handy when you register. Both of these numbers can be found on your welcome letter and your member ID card. Register now.


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Can I receive my monthly premium bill in Spanish?

Yes, if you have an individual or family plan your premium bill is available in Spanish. If you would like to receive available Spanish communications, you can log in to your Blue Access for MembersSM account, go to the Settings tab and choose Preferences. You can also call the Customer Service number on the back of your member ID card. Customer Service will be happy to record your preference.


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What communications are available in Spanish?

Members can receive Explanation of Benefits (EOB) statements in Spanish. If you would like to receive available Spanish communications, you can log in to your Blue Access for MembersSM account, go to the Settings tab and choose Preferences. You can also call the Customer Service number on the back of your member ID card. Customer Service will record your preference.

We also have the following tools available to meet the Spanish language preference of our members:

  • Spanish language website — Browse health plans, get information on member services and tips for using your health insurance
  • Provider Finder in Spanish — Locate medical professionals who speak Spanish in your area
  • "Pregúntele a Sara" — Get answers to typical health plan questions using the tool found at the top of the website
  • Member Voice Videos in Spanish — See how our health insurance plans have helped members
  • Assistance Finder in Spanish — Find a nearby Spanish speaking representative to answer your health insurance questions
  • BCBSTX App — Access your secured health plan information easily on your mobile device. The App will open in Spanish if the device language is set to Spanish.
  • Facebook Latino  — Follow us on Facebook en español for content and posts in Spanish

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I missed the open enrollment deadline. Can I still buy health insurance?

In most cases, you can only sign up for a health insurance plan during the open enrollment period. If you missed open enrollment, you may be able to enroll during the special enrollment period. To be eligible, you must have had a qualifying "life event" within the past 60 days or experienced other complications that did not allow you to complete your enrollment . Learn more about special enrollment.


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I bought my health plan on the Health Insurance Marketplace. How can I make changes to that account or profile?

This Contact Guide PDF Document has the phone numbers and instructions you’ll need. Find the change you’d like to make, then learn where to get started.


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I received a letter from Equian (formerly Trover Solutions) saying they have partnered with BCBSTX to investigate my medical claim. Should I respond to the letter?

BCBSTX and Equian have partnered to review the medical claim listed on your letter to determine if another person or insurance company should be responsible for the claim. The claim we are investigating may be for treatment you received from an injury experienced at work or from an auto accident.

The information we are requesting is important. It could help to get back money that should be paid by someone else, like another insurance carrier. This process is one of several tools used by BCBSTX to help control rising costs of health care. Call the number, 800-696-4573, on the letter to answer the claim question.


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What are my options to pay my premium?

Here are convenient ways you can pay your bill.


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BCBSTX drafted my bank account twice. When will I get my money back?

We sincerely apologize for our error in drafting your bank account twice for your premium payment. We had two active policies for you in our system, which pulled your records twice when the automated drafts were processed. We have corrected the error in our system, so this should not happen again. We will mail a refund check for the overpayment amount within 5 days of the error. If you don't see it soon, please give us a call. In addition, if you had overdraft fees as a result of the double billing, please contact us so we can refund these charges as well. You can reach us at 800-792-8595.


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I applied for a plan on the Health Insurance Marketplace and also applied for a plan directly with BCBSTX, so now I'm getting a bill for both. How do I cancel one?

We cannot process a cancellation request for a Marketplace plan. If you want to cancel your Marketplace plan, you can call the Marketplace at 800-318-2596. If you want to cancel our off-Marketplace plan, we can process that cancellation for you. Call Customer Service at 800-538-8833. You can also log in to your Blue Access for Members account and send us a secure email message.

A policy will also automatically be cancelled for nonpayment if you don't pay the premium. This may be your best option. You would simply pay the premium for the plan you want to keep and not pay the premium for the plan you want to cancel.

Members can log in to their Blue Access for Members account from a desktop or mobile browser for more information about benefits, claim status and more.


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What is an HMO? How is it different from other health care plans?

A Health Maintenance Organization (HMO) is a type of health plan that gives you access to certain doctors and hospitals that have contracted with the HMO, often called a provider network or just network. An HMO is different from other health care plans in a number of ways:

  • An HMO is designed to control costs through preventative health care services that help you avoid serious and costly health problems.
  • An HMO typically has lower monthly premium and lower copayment levels than other types of plans.
  • HMO networks are not limited to doctors and hospitals. HMO networks include clinics, pharmacies, labs, imaging centers and medical equipment vendors.
  • When you join an HMO, you selected or were assigned a primary care physician (PCP) to coordinate all your health care services.
  • Also, HMOs generally only cover health care services provided by a network of health professionals and hospitals that together provide a full range of health care services. When choosing your new plan, make sure the doctors and hospitals you want to use are all in the HMO's network.

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What types of doctors can be a primary care physician?

The following doctors can be selected as a primary care physician:

  • Family medicine doctor
  • OB/GYN
  • Pediatrician
  • Internal medicine doctor

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How do I select a primary care physician (PCP)?

Use our Provider Finder® online directory to find the PCP in the HMO network who best fits your needs. Be sure the doctor you select is accepting new patients.

It's easy to use the Provider Finder by registering for Blue Access for MembersSM (BAM):

  1. Visit Blue Access for Members.
  2. Use the information on your BCBSTX member ID card to complete the registration process.
  3. Once you are registered, log in to BAM. The Provider Finder tool is located under the Doctors & Hospitals tab.
  4. Know the name of your plan and choose it from the dropdown box "Select network type".
  5. Continue to search until you find a doctor who meets your needs and is accepting new patients.

TIPS:

  • Check your Benefit Booklet for your Network Type
  • Make sure you are searching within your network
  • Enter as much information as you know
  • Use filters to help narrow your search

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What happens if I don't select a primary care physician (PCP)?

You must have a primary care physician assigned. If you don't select your own, we will assign one to you.


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How do I change my PCP?

You can call the Customer Service number on the back of your member ID card to identify your new primary care physician (PCP) selection. You can also change your PCP by logging in to your Blue Access for Members account and clicking "Doctors and Hospitals." Before you change, make sure the PCP you are requesting is in your network and accepting new patients.


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Do I need a referral to see a specialist? How do I get a referral?

Your primary care physician (PCP) will provide you with a referral to a specialist, if you need to see one. Always contact your PCP first for any care you need, unless it's an emergency.

Women do not need a referral to see an in-network OB/GYN designated as a Woman's Principal Health Care Provider (WPHCP). Children do not need a referral to see their in-network pediatrician or family medicine physician, that can also serve as a PCP.


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Can I continue to see my current doctor when I join the HMO plan?

Yes, if your current doctor is a part of the HMO's network. If your doctor is not in the network, you will need to select a new primary care physician (PCP). To make sure a provider is in the HMO network, search Provider Finder®, our online directory.


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Do I have coverage if I am traveling?

In an emergency, go directly to the nearest hospital. For other needs, some HMO plans allow you to get health care services from a Blue Cross and Blue Shield affiliated doctor or hospital when you are traveling outside of Texas. If you aren't sure, contact customer service at the number on the back of your member ID card before you go. And always remember to carry your current BCBSTX member ID card. It contains helpful information for accessing health care at home or away.


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What if I'll be away for more than 90 consecutive days?

If you or a covered family member will be temporarily living outside of Texas for 90 days or more, you may be eligible for guest membership in a Blue Cross and Blue Shield-affiliated HMO. In some circumstances, moving can also qualify you to be able to enroll in a new plan in your new location. You can call the customer service number on the back of your ID card to find out if your plan covers you when living outside Texas and to discuss your options.


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What if I'm already in treatment when I enroll and my doctor isn't in the network?

We'll work with you to provide coverage for the most appropriate care for your medical situation, especially if you are pregnant or receiving treatment for a serious illness. You may still be able to see your current provider for a brief time. Call us at the Customer Service number on the back of your BCBSTX ID card for more information.


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How do I work with my primary care physician if I have a chronic or pre-existing condition?

When you join an HMO your doctor, known as a primary care physician (PCP), coordinates all your care, including referrals to specialists if needed. If you are already seeing a specialist for your condition, make sure that specialist is in your plan's network. If the specialist is not in your plan's network, in most cases you will pay more. You will still need a referral from your PCP to see a specialist.

  • Step 1 — Discuss your medical conditions or concerns with your PCP.
  • Step 2 — Your PCP will refer you to a specialist in your plan's network and send your information to the specialist. Make sure that the specialist you are referred to is in your network. Just call customer service at the number on the back of your BCBSTX ID card before your first office visit.
  • Step 3 – Call the specialist's office to make an appointment.

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Does my plan cover prescriptions?

Your BCBSTX HMO benefits also cover prescription drugs. Not all drugs are covered. You can visit our website to view the list of prescriptions your plan covers. This list is called a preferred drug list. You can also have your doctor check before writing a prescription. To look for your medicines, you will need to know:

  • The medicine's exact name
  • The dose you take
  • How many pills your doctor often prescribes for you

While costs can vary depending on your benefit plan, you usually pay less for generic drugs and more for brand name drugs. Your plan may cover some of the costs of drugs not on your preferred drug list. You can learn more by looking in your benefit book, or calling the customer service number on the back of your ID card.


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Frequently Asked Questions

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* BCBSTX has contracted with a third-party vendor, Alacriti Payments, LLC, to process your ACH/electronic check payment. In order to process this payment, you will be redirected to Alacriti's secure payment site, OrbiPay. If you have any problems with your payment, please contact BCBSTX customer service at 800-538-8833.