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Find A Doctor Or Hospital In Your Network.
HMO stands for Health Maintenance Organization. It’s a type of health plan that gives you access to a network of doctors and hospitals, often called providers. This group of health care professionals work together to provide you with a full range of covered health care services. HMO is different from PPO (Preferred Provider Organization) insurance in a few ways.
When you sign up for an HMO plan, you first choose to select or be assigned a primary care physician (PCP) from a network of doctors.
If you need to see a specialist or need any special tests, you will need a referral from your PCP before seeing another doctor. You can use the Provider Finder search tool to make sure the specialist is in your network. To access the tool, log in to your Blue Access for MembersSM (BAMSM) account and click Find Care in the top navigation menu.
Remember, if the specialist isn’t in your network, or if you haven’t received a referral from your PCP, the services won’t be covered.
An HMO is a good choice for a lot of reasons. Making sure you follow HMO rules will make sure you get the most of benefits:
Whenever you have questions about your HMO plan, use our handy resources. Sign up for Blue Access for MembersSM (BAM) or call the customer service number listed on your member ID card. BAM lets you keep track of your balances, claims status, benefits, coverage details and more.
If you’re not a member yet but are considering buying an HMO Insurance plan, check out our shopping guide.
Originally published 10/7/2014; Revised 2021, 2022
Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association
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