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 referral 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 Woman's Principal Health Care Provider (WPHCP).
- 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)
PCPs are doctors or medical professionals who focus on general practice, internal medicine and family practice. If you are a female member, you may have also selected a WPHCP. A pediatrician can serve as your child's PCP.
- Find your medical group on the front of your BCBSIL member ID card or in Blue Access for MembersSM, our secure member website.
- If you're a new patient, see your PCP as soon as possible. Tell him or her you're a new patient when you make your first appointment. This will help avoid delays when you are sick or need a referral.
- You can change your PCP or medical group/IPA at any time, except while hospitalized or in the 2nd or 3rd trimester of pregnancy.
- To change doctors within the same medical group: Call the medical group (MG/IPA) shown on your card and ask to change doctors. Use Provider Finder to find doctors in your medical group.
- To change to a different medical group:
- Log in to Blue Access for Members
- Select the Doctors & Hospitals tab
- Select the Change MG link
- Follow the instructions
Call the Customer Service number on the back of your BCBSIL member ID card.