If you like having the flexibility to choose the doctors, hospitals and other health care providers you use to get care, and you can afford to pay more, PPO private insurance may be the right plan for you and your family.
PPO plans let you choose where you go for care, without needing a referral from a primary care provider (PCP) or relying only on providers in your plan's network. They typically have higher monthly premiums and out-of-pocket costs like copays, coinsurance and deductibles. With Blue Cross and Blue Shield of Texas you have different levels of a plans, like Silver PPO plans, to meet your budget and health needs.
A PPO may be a good choice for you because:
- You don't need a PCP to coordinate your care.
- You don't need a referral to see a specialist.
- You can get care from in-network or out-of-network providers.
Provider Network
A PPO plan has a certain group of health care providers you can use when you need care. This is called your PPO network.
Your PPO network may include care and services from certain:
- Doctors
- Hospitals
- Pharmacies
- Labs
- Imaging centers
- Medical equipment vendors
You can get care from providers not in your plan's network, but you will pay more for your out-of-pocket costs.
How Do I Know If a Provider Is In My Network?
To make sure a provider is in your plan's network, search our Find Care tool . This tool allows you to find the doctors, hospitals and other providers covered by your plan.
If you're a BCBSTX member, register or log in to Blue Access for MembersSM, our secure member website, for a personalized search based on your health plan and network.
How To Use Your PPO
- You may need to get prior authorization (or pre-authorization) from BCBSTX before getting certain tests or services. Your doctor's office will call the prior authorization number listed on your BCBSTX member ID card to confirm. You can also call before you go for care or to confirm your doctor's office has gotten the needed authorization.
- For non-emergencies. For a common illness or injury, like a cold, flu, minor cut or burn, you have a few options to get care. These are less expensive than going to the emergency room.
- In an emergency. When your injury or illness is serious or life-threatening, call 911 or go to the nearest emergency room. You won't have to pay the higher out-of-network deductible and coinsurance if it is an emergency.
- For specialists, behavioral health or hospital care. You do not need a referral to see a specialist or behavioral health care provider. You also don't need a referral to visit a hospital. You can get care from an in-network or out-of-network provider, but you will likely pay more for non-emergency services if you don't stay in network.