I just heard that my doctor and hospital may go out of network? What does that mean?
To answer your question, it's important to understand what a network is and why a doctor or hospital may choose to leave our provider networks. Know that first and foremost, what you pay for health care and the quality of care you receive is at the heart of our negotiations with providers. We strive to do everything in our power to stand with you in sickness and in health.
You can log in to Blue Access for MembersSM 24/7 to access your benefits information or call Customer Service at the number listed on your BSBSOK member ID card.
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.
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.
Even if you haven't received your BSBSOK member ID card, you should have received a new member welcome letter within days of your enrollment being completed.
Your member identification and group numbers 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.
We receive new applications from the Marketplace exchange every day. If you applied through the exchange, it will take a few days for processing through the exchange before your application is sent to us. It then takes us about 5–10 business days to process your enrollment in the BSBSOK 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 exchange or with BSBSOK online and you have not received information from us, call our Customer Service Center at 1- 866-520-2507 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.
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.
Your member ID cards will only have the primary subscriber's name on them, but they can be used by all the dependents (in this case your spouse) enrolled under your policy.
Within days of your application being accepted, you will receive a welcome letter from BSBSOK 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.
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:
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 BSBSOK, ask the caller for a number you can use to call us back.
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.
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 Members account, go to the Settings tab and choose Preferences. You can also call the customer service number listed on 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:
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.
This Contact Guide has the phone numbers and instructions you’ll need. Find the change you’d like to make, then learn where to get started.
BCBSOK 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 BCBSOK to help control rising costs of health care. Call the number on the letter to answer the claim question.
What are my options to pay my premium?
Here are convenient ways you can pay your bill.
We sincerely apologize for our error in drafting your bank account twice for your premium payment. This occurs when we have two active policies for you in our system, which pulled your records twice when the automated drafts were processed. Call our billing office at 1-800-792-8595 to report this so we can correct the error in our system, if we haven't already, so this will not happen again. We will mail a refund check for the overpayment amount within 5 days of correcting 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 call our billing office so we can refund these charges as well.
We cannot process a cancellation request for an Exchange plan. If you want to cancel your Exchange plan, you can call the Exchange at 1-800-318-2596. If you want to cancel our off-Exchange plan, we can process that cancellation for you. Call Customer Service at 1-800-538-8833. 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.
Log in to your Blue Access for Members account from a desktop or mobile browser for more information about benefits, claim status and more.
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:
The following doctors can be selected as a PCP:
Use our Provider Finder® online directory to find a 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 Members:
You must have a primary care physician assigned. If you don't select your own, we will assign one to you.
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.
No, you do not need a referral. However, if the specialist is not in your plan's network, in most cases, you may have to pay for services which are considered out-of-network.
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.
In an emergency, go directly to the nearest hospital. For non-emergencies, 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 New Mexico. If you aren't sure, contact customer service at the number listed on your member ID card before you go. And always remember to carry your current BCBSOK member ID card. It contains helpful information for accessing health care at home or away.
If you or a covered family member will be temporarily living outside of New Mexico 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 listed on your member ID card to find out if your plan covers you when living outside New Mexico and to discuss all your options.
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 listed on your BCBSOK member ID card for more information.
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.
Your BCBSOK 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. To look for your medicines, you will need to know:
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 listed on your member ID card.
* BCBSOK 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 BCBSOK customer service at 1-800-538-8833.