Blue Cross and Medicare sitting in a tree making network money off the Seniors & Elderly, first comes the money then your health. Wealth b4 ur healt

Provider Directory

Blue Medicare PPO Provider Directory

The Blue Medicare PPO plan is a preferred provider organization (PPO) plan. All Blue Medicare PPO contracted network providers are available to the members through self-referral, with the exception of services that require preauthorization. We work with our contracted health care practitioners to help ensure that care is accessible, coordinated, timely, and provided in a manner and setting that promotes positive patient-physician relationships. The Texas Provider Directory (PDF, 1298KB) provides a list of the Blue Medicare PPO network providers.

The Provider Directory also provides a list of Blue Medicare PPO's network pharmacies. We call the pharmacies on this list "our network of pharmacies" because we have made arrangements with them to provide prescription drugs to Plan members. A network pharmacy is a pharmacy where beneficiaries obtain prescription drug benefits provided by Blue Medicare PPO. In most cases, your prescription drugs are covered under Blue Medicare PPO only if they are filled at a network pharmacy or through our mail order pharmacy service. You are not required to go to the same pharmacy to fill your prescriptions, you can go to any of our network pharmacies. We will fill prescriptions at non-network pharmacies under some special circumstances. For additional details, you can check the Evidence of Coverage (PDF, 371KB)

Our Service Area:

The Blue Medicare PPO provider network is comprised of contracted hospitals, provider groups, and independent physicians. You should check the on-line Provider directory for the current list of network providers.

Can I choose my doctors?

Blue Medicare PPO has formed a network of doctors, specialists and hospitals. You can use any doctor who is part of our network. You may also go to doctors outside of our network. The health providers in our network can change at any time. However the listing found on this site is updated monthly.

What happens if I go to a doctor who isn't in the network?

You can go to doctors, specialists or hospitals in-network or out-of-network. You may have to pay more for the services you receive outside the network, and you may have to follow special rules prior to getting services in- and/or out-of-network.

Referrals and Care from an Out-of-Network Provider

Your out-of-pocket costs will be higher if you use out-of-network providers than if you use network providers. When network providers are not available in your service area due to network inadequacy or continuity of care and you have to use out-of-network providers for your medical services, Blue Medicare PPO will waive the out-of-network deductible and pay for the services at the in-network benefits levels.

Although referrals are not required by our plan, you may wish to get a prior authorization to receive a lower cost to you. When you have an appointment with an out-of-plan or out-of-network physician/professional provider which is necessary due to network inadequacy or continuity of care, to receive the lower out-of-pocket cost, the services must be reviewed and authorized by Utilization Management prior to you receiving care.

You need to obtain prior-authorization for the request for an out-of-network provider to be paid as in-network by calling 1-800-441-9188 for the Utilization Management area.


Back to top
SIDE NAVIGATION
Questions?

For more
information call:

1-866-308-4781

For the hearing or speech impaired:

1-800-538-0380

8 a.m. - 5 p.m., CST, Monday - Friday

FAQs

Who is eligible to enroll for Blue Medicare PPO?

How is Blue Medicare PPO different from Medicare Supplement health insurance coverage?

How can Blue Medicare PPO be offered at such an economically priced plan premium?

What would my payment responsibility be if it becomes necessary for me to use an out-of-network specialist provider due to a network inadequacy?

Related Information

Adult Wellness
Guidelines (PDF, 92KB)

Medicare.gov*

Enrollment Information

Summary of Benefits (PDF, 116KB)

Evidence of Coverage (PDF, 371KB)

Terms & Conditions

Grievances, Appeals and Exceptions

Privacy Notice

Contact Us

* By clicking this link, you will leave the Blue Medicare PPO Web site.


FOOTNOTES

* By clicking this link, you will leave the Blue Medicare PPO Web site.

PDF indicator Indicates a file in portable document format (PDF). To view this file, you may need to install Adobe® Reader®*.

The latest version of Adobe Reader has built-in screen reader capability. Other accessibility tools and information can be downloaded at http://access.adobe.com*. If your screen reader cannot read these PDFs, download the latest version of Adobe Reader*, with built-in screen reader capability. Other accessibility tools and information can be downloaded at http://access.adobe.com*.

H4531_WEB_Websitef

File & Use Certified

Last updated 7/12/2007
FOOTER

SM Service Mark of the Blue Cross and Blue Shield Association, an Association of Independent Blue Cross and Blue Shield Plans

® Registered Service Marks of the Blue Cross and Blue Shield Association, an Association of Independent Blue Cross and Blue Shield Plans.

Blue Cross and Blue Shield of Texas refers to HCSC Insurance Services Company, which is a wholly owned subsidiary of Health Care Service Corporation, a Mutual Legal Reserve Company. These companies are independent licensees of the Blue Cross and Blue Shield Association and offer or provide services for Medicare Advantage and Medicare Part D products under HCSC Insurance Services Company's contract H4531 with the Centers for Medicare and Medicaid Services.