Blue Cross Blue Shield HMO Providers

Blue Cross Blue Shield HMO Providers – Overview

A Blue Cross Blue Shield (BCBS) HMO is a health maintenance organization. It is designed to provide predictable and low-cost medical and healthcare services.

An HMO has a single doctor coordinating your health care, which makes an HMO health plan easy to use and is ideal for those who are looking for a health plan that is easy to understand, easy to use, and easy on your wallet.

Blue Cross Blue Shield HMO Simplifies Healthcare

A Blue Cross Blue Shield HMO offers health plans with:

  • Monthly premiums, deductibles and copays are usually less than other similar health plans
  • Access to a group of certain hospitals and doctors (called HMO provider network) which helps to ensure a limit on how much you spend on health care expenses
  • A primary care physician who you visit for routine checkups, colds, flu, and annual exams can refer you to a specialist for more serious health problems
Blue Cross Blue Shield HMO Providers

Is Blue Cross Blue Shield HMO Personal?

Blue Cross Blue Shield HMO is a Personal

An HMO health plan is designed to offer personalized health care for recipients. Your healthcare is completely coordinated by a single doctor who is familiar with your medical history, current health problems, medications, lifestyle, and how your family’s health history can affect your health.

The first step to receiving HMO healthcare benefits includes signing up for an HMO health plan. For this, you can choose or get assigned to a particular primary care physician who is part of a medical group (MG) or an independent practice association (IPA).

Every person on your plan gets to pick their primary care physician. These doctors mostly focus on general internal medicine or family medicine. Based on plan rules, members, regardless of gender, may have the option to choose a specialist, such as an OB/GYN, as their primary care physician, not limited to girls and women.

On the other hand, older adults can also choose a geriatrician, while children can be assigned a pediatrician as their primary care physician.

As a member of Blue Cross Blue Shield, you can find information about your medical group or primary care physician through your online member account or by contacting customer service, as specific details may not be directly listed on the front of your member ID card.

Alternatively, you can also find your assigned primary care physician by logging in to the official website at

You can also read the whole set of guidelines about interacting with your primary care physician under the Blue Cross Blue Shield HMO plan by downloading the guide at

Blue Cross Blue Shield Primary Care Physician Services

Your primary care physician is your partner in keeping you healthy.

Make sure to follow these guidelines to ensure a smooth and functional relationship with your primary care physician:

See your primary care physician right away

If you are new to the plan and make your first appointment, let the doctor’s office know that you are a new patient. Going to the primary care physician soon after enrolling helps to avoid delays if you are sick and need medical care or a referral.

Get a referral for a specialist

If you need to see a specialist or behavioral health care provider, your primary care physician can help you by referring you to one. Make sure that the specialist you have been referred to is part of your HMO network. Women usually don’t need a referral to visit an in-network Woman’s Principal Health Care Provider (WPHCP).

Besides this, you will need a referral from the primary care physician to visit a hospital for non-emergency-related medical services. You can find the list of in-network hospitals and healthcare providers in the Provider Finder section on the official Blue Cross Blue Shield official website.

Call When You Need Medical Care

Your primary care physician should be the first one you visit for any medical care. If their office/clinic is closed, then you can call their after-office number too.

For a common illness or injury, your primary care physician will usually fit you into their schedule or may refer you to another doctor or clinic nearby, which is also part of your HMO network. When required, your primary care physician may also refer you to a hospital.

For Medical Emergencies

In case you are suffering from a life-threatening injury or illness, you should call 911 or rush to the nearest emergency room. You don’t need to go to in-network HMO providers or get a referral. Simply inform your primary care physician about your medical emergency as soon as possible so they are able to follow your treatment and offer any advice or service if needed.

For Affordable Healthcare Services

HMO health plans are made to lower costs through preventive health care. It helps you, the recipient, to avoid serious and expensive health care costs. HMOs keep the cost so low because the doctors and hospitals in the HMO network agree to offer healthcare services at a fixed price.

The HMO network can provide a plethora of healthcare services, such as:

  • Physicians
  • Hospitals
  • Pharmacies
  • Clinics
  • Imaging centers
  • Labs
  • Medical equipment vendors

Your HMO health plan typically does not cover services received from out-of-network providers except in emergencies, emphasizing the importance of staying within the HMO network for care. The reason is that healthcare providers set their own prices for every service they offer. Prices for the same healthcare service can significantly vary among providers, underscoring the cost-effectiveness of using in-network providers under an HMO plan.

As Blue Cross Blue Shield signs contracts with its in-network providers to offer their services at a fixed price, you get affordable healthcare services at in-network healthcare facilities.


You can find out if a healthcare provider is part of your HMO network by visiting the official BCBS website and checking the “Provider Finder” feature. This feature also has an online cost estimator to help to find the costs for health visits, different treatments, surgeries, diagnostics, immunization and many more healthcare services.

See Also

Blue Cross Blue Shield of Illinois

Blue Cross Blue Shield of Michigan

Blue Cross Blue Shield of Florida

Blue Cross Blue Shield Telehealth Grants

Blue Cross Blue Shield IVF Coverage

Grants for Autism Service Providers

Current Version
October 15, 2022
Written By
Shubham Grover
March 18, 2024
Updated By
Andrea Morales G.

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