We’ve heard from our customers that being able to see their preferred doctor or using their hospital of choice is a top priority when considering a health insurer. With 96% of all eligible providers participating in the Blue Cross and Blue Shield of Kansas networks, including 99% of all medical doctors and 100% of all acute care facilities, we’re proud to offer our members an array of choices for their care. But we also understand that knowing when and how to access that care can be complicated. To help alleviate some of the confusion, we’ve put together a detailed guide to break down this complicated subject.
Know your network
First, let’s start with learning about the network that’s part of your health insurance plan. A network is the group of facilities, providers and suppliers your health insurer has contracted with to provide health care services. In other words, they are the doctors, hospitals and other medical facilities that have agreed to contract with BCBSKS to provide you care at a discounted rate. That’s why you may have heard that it’s important to choose a provider that’s “in-network.” Choosing a provider that’s “out-of-network” will have you paying more for the care you receive.
An insurance company can have several networks for their members, so it’s important to know which one is associated with the health insurance plan you’re enrolled in. The easiest way to do this is to look at your member ID card. For BCBSKS members, the name of the network is printed in the top-right corner of your ID card.
One quick, but important caveat – if you’re one of our members who has Plan65 (our Medicare supplement plan), your network for medical care works a bit differently. Plan 65 members don’t have a specific list of BCBSKS contracting healthcare providers from which to choose. However, you will receive the highest level of benefits for your plan when you choose a healthcare provider who accepts Medicare assignment. If you don’t know whether your doctor, hospital or other healthcare providers accept patients with Medicare, contact your local Medicare office.
Finding a doctor
There are a few things to think through when you’re deciding to see a new doctor. Because this person will be the one you’re primarily working with for your health, it’s important to find one that’s right for you. Consider the following:
- Is this doctor in your network? If they aren’t, you’re likely to be paying more to see them. Additionally, you’ll want to make sure the both the clinic and the doctor are contracting with BCBSKS. For example, if a doctor is new to a clinic they may not be immediately considered in-network by BCBSKS until we have finalized the review process. BCBSKS members can easily search for a doctor or specialist in their network by using our Find a Doctor/Hospital tool.
- What types of reviews does this doctor have among friends, family or in the community?
- Is their office close to your home or work?
- Is the office staff friendly and helpful?
Additionally, it’s important to remember that even though your doctor recommend a service, it doesn’t mean it’s covered under your coverage or that it would be considered medically necessary. It’s always best to check your coverage before going through with the service.
Check out these other resources when it comes to the importance of choosing and having a personal physician.
Alternative options for care
Seeing your primary doctor on a regular basis is crucial to maintaining a healthy lifestyle. However, we know that it isn’t always possible to see them when a medical issue arises. Fortunately, there are other options that allow you to see or speak with a medical professional. In the case of a true emergency, you should always go to the nearest hospital. For less severe complaints, you may get faster and less expensive treatment elsewhere.
- Emergency care – If you’re seriously sick or injured, a trip to the emergency room can save your life. You should always head there if your experiencing symptoms like trouble breathing, head trauma or sudden confusion, chest pain or pressure, or uncontrollable bleeding, vomiting or diarrhea.
- Urgent care – If you aren’t able to get an appointment with your doctor, an urgent care center can assist you with things like minor cuts, burns, sprains or ear infections.
- Telemedicine – For the times when you’re too sick to travel or you’d rather keep a child or elder in your care at home, a virtual doctor appointment may be the solution. Telemedicine is a fast, convenient way to see a doctor virtually. BCBSKS members can have a live visit on their computer or mobile device with a doctor at a time that works for them. Learn more about our telemedicine services and whether your plan covers this type of benefit on our website.
Getting care away from home
Life is going to take you on all kinds of adventures. Whether you’re on a summer road trip or visiting family for the holidays, make sure you understand the health insurance coverage you have when you’re away from home. For BCBSKS members, rest assured that you can receive your health care benefits through the BlueCard® Program. BlueCard is a national program that enables Blue Cross members to get the medical care they need while traveling or living in another Blue Plan’s service area. The program links participating health care providers with the independent Blue Cross and Blue Shield Plans across the country, and in more than 200 countries and territories worldwide, through a single electronic network for claims processing and reimbursement. Here’s an example of how it works:
If a BCBSKS member is visiting friends in Texas and they slip off the sidewalk and break their foot, the provider that treats them will be paid the rate Blue Cross and Blue Shield of Texas has negotiated with the local hospital. The member will still be responsible for out-of-pocket costs, like a copay, but the medical costs for the member will be lower than having out-of-network coverage.
Your health insurance coverage can help you lead a healthy life, but we understand that navigating the complexities of a health insurance network can leave you with more questions than answers. We hope this guide answers the questions you have about getting the care you need, but if you have more, don’t hesitate to visit our website or give us a call at 1-800-432-3990. We’re here for you!