How BlueCard PPO Works

How BlueCard PPO Works

1. Clients should always carry their most current Blue Card and Blue Shield of Texas (BCBSTX) ID card.

2. If outside the BCBSTX service area and health care is needed, refer to the ID card and call BlueCard Access at 1-800-810 BLUE (2583) for information on the nearest BlueCard preferred provider organization (PPO) contracting doctors and hospitals.

3. The member is responsible for calling the local BCBSTX health plan for precertification, when necessary. Refer to the precertification phone number on the ID card, as it differs from the BlueCard Access number.

4. Upon arrival at the doctor's office or hospital, the member will present the ID card and the doctor or hospital will verify membership and coverage information.

5. After receiving medical attention, the claim is routed to the member's BCBSTX plan for processing. All doctors and hospitals are paid directly, relieving the member of hassle and worry.

6. The member will pay for non-covered services, as well as deductible, copayment or coinsurance amounts. The member's BCBSTX plan will send a detailed Explanation of Benefits (EOB) to the member.

• Summary of BlueCard Program

• Advantages of BlueCard