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HealthSelectSM of Texas is a point-of-service plan. Consumer Directed HealthSelectSM and HealthSelect Out-of-State are preferred provider organization (PPO) plans. In both types of plans what you pay for care depends on the provider. You will pay less if you go to a provider in the network, but if you want to go to a provider who isn’t in the network, you can. You’ll still get coverage, you’ll just pay more.
Here are three ways you’ll pay more if you go out of the HealthSelect network for care:
- You’ll have to pay an out-of-network deductible before the plan pays anything. (With Consumer Directed HealthSelect, the out-of-network deductible is twice as much as the in-network deductible.)
- After you meet the deductible, you’ll have to pay out-of-network coinsurance.
- You won’t get the lower price the plan negotiates with an in-network provider (referred to as the allowable amount or negotiated rate) and you may be responsible for the difference between the amount billed by the provider and the allowable amount. This is known as balance billing, and the cost could be significant. HealthSelect participants in Texas have access to more than 50,000 network doctors, providers and hospitals across the state. (If you live or work outside Texas, you also have a large provider network).
To make the most of your health care benefits:
- Choose a primary care physician (PCP) from the many providers who are in the HealthSelect network.
- Get a referral from your PCP for any specialist care. If you see a specialist without a referral, you’ll pay out-of-network costs, even if the specialist is in the HealthSelect network. Also, keep in mind that only your PCP can give you a specialist referral. If the specialist you see refers you to a second specialist, you must get a referral for the second specialist from your PCP. (HealthSelect Out-of-State, Consumer Directed Health Select, and HealthSelect Secondary participants do not have to get referrals to specialists.)
- Before seeing a specialist—even if referred to him or her by your PCP—double-check his or her status. That’s true for specialists at in-network hospitals and other facilities. Just because the hospital is in the network doesn’t mean everyone practicing there is. Also, keep in mind that some specialists may be in network only when they are working at a specific location. If the specialist you’re seeing works out of more than one office or facility, make sure you’re seeing him or her at a location that’s in the network.
- If you need any tests done, check to see if these tests are done in an in-network facility or lab. For example, if you need to get blood drawn, ask your provider to send you to an in-network lab. Ask your PCP to send in-office tests—such as cultures obtained to check for pneumonia or strep throat—to an in-network facility or lab.
Call a BCBSTX Personal Health Assistant toll-free at (800) 252-8039, Monday–Friday 7 a.m. - 7 p.m. and Saturday 7 a.m. - 3 p.m. central time.