https://connect.bcbstx.com/understanding-benefits/en-USTelligent Community 12https://connect.bcbstx.com/understanding-benefits/b/weblog/posts/pharmacy-benefit-vs-medical-benefitThu, 30 Jul 2026 15:02:00 GMT6e104328-2028-43b6-bb31-8401437dc51f:9d76183a-74a4-4dc2-b76b-376e10c82f4aBCBSTX Connect TeamIt’s no secret that prescription drugs can be pricey. One of the best ways to save on the drugs you are prescribed is to make sure you understand how your health plan benefits work. A good place to start is to answer this question: Is my prescription drug a pharmacy or medical benefit? In most cases, a prescription drug is covered under your pharmacy benefit . There are times, though, when a prescription drug is considered a medical benefit . Here is a breakdown to help you understand which is which. Drugs That Fall Under Your Pharmacy Benefit Think about the common medicines you pick up at your local drugstore or have delivered to your home. Drugs that help keep your blood pressure or cholesterol in check. The cream your dermatologist gave you for that itchy rash. Antibiotics for a sinus infection. Or insulin to manage your diabetes. These are just a few examples of prescription medicines you may take that may be part of your pharmacy benefit. Drugs That Are a Medical Benefit Sometimes, medicines must be given by a care provider in a health care setting. Birth control implants are one example. So are chemotherapy infusions for cancer and immunotherapy for complex and chronic diseases. These types of medicines usually require patients to be monitored by a medical professional during their treatment. Your medical benefit may cover the costs of these drugs and their administration. Some Drugs Can Be Both Vaccines given as part of preventive health care can be either a pharmacy benefit or a medical benefit. A flu shot is the most common example. Did you go to your local retail pharmacy for your flu shot? Or did your primary care provider give you a flu shot during your annual wellness check? The benefit category for the vaccine depends on your health plan and where you got it. Of course, understanding the details of your Blue Cross and Blue Shield of Texas plan is one of the best ways to get the most out of your pharmacy benefit. Here are some things you can do: Check Your Plan’s Drug List The list is exactly what the name suggests — a list of prescription drugs covered by your health care plan. The list is organized into different levels of coverage called member payment tiers. Some plans may have up to six tiers. Each tier has its own cost. The lower the tier, the lower your out-of-pocket costs will be for the drug. Generic drugs are usually found in the lower tier. Name brand drugs and specialty drugs are often in higher tiers. You may pay more for a brand name drug if you choose the brand name drug when a generic equivalent is available. Talk with your doctor and pharmacist about all your medicines. Always check to see if they are covered under your health care plan. For any name-brand drug, ask if there are generics or lower-cost options you can take. If your drug isn’t covered on your drug list, ask if there are other covered drugs or treatments that your needs. To check your drug list, log in to your member account online or through the BCBSTX App . Be In-the-Know About In-Network Pharmacies BCBSTX works with a broad network of pharmacies. When you use an in-network pharmacy, your out-of-pocket costs are often less. You may also be able to get up to a 90-day supply of covered drugs you use regularly . Understand Special Requirements and Limits Sometimes, you may need to meet certain criteria before your prescription drug coverage is approved. Members who use a specialty drug to treat a complex or rare condition may need to follow specialty pharmacy program guidelines. Some drugs may have limits on how much medicine can be dispensed per prescription or in a given time span. Your doctor may need to get prior authorization before your drug is covered. You might need to use step therapy , which means you must try a more cost-effective drug first before moving to another higher cost drug. To review your pharmacy benefits, you can: Log in to your online member account or the BCBSTX App to see in-network pharmacies, get cost and coverage information, check refills and more. Call BCBSTX customer service at the number on your member ID card. Prime Therapeutics LLC is a separate company contracted by Blue Cross and Blue Shield of Texas to provide pharmacy solutions. BCBSTX, as well as several independent Blue Cross and Blue Shield Plans, has an ownership interest in Prime Therapeutics.PrescriptionsBenefits and CoveragePharmacyGeneric drugsPharmacy BenefitsDrug Listin-networkhttps://connect.bcbstx.com/understanding-benefits/b/weblog/posts/make-most-of-plan-year-endThu, 30 Jul 2026 10:33:00 GMT6e104328-2028-43b6-bb31-8401437dc51f:6daa6fa4-68a3-4cc2-b740-1eb0d5835e47BCBSTX Connect TeamIf you’re the kind of person who needs a deadline to get things done, there may be a big one just around the corner. If your health plan year is ending soon, it’s a good time to review your health benefits. Doing so could be a boost to your overall health — and could even save you money. That’s because you might have benefits you want to use before the end of the plan year. It pays to check it out and make a few appointments. Deductibles Looking at your health benefits now may save you money. If your plan has a deductible and you’ve met it, you might want to schedule care your doctor has been recommending now, rather than waiting until your next plan year. A deductible is the amount you pay for health care services each plan year before your health plan starts to pay. For example, if you have a $1,500 deductible, you pay the first $1,500 of the services you need. Once you’ve met your deductible, you usually pay only a copay and/or coinsurance for covered services. Coinsurance is when your plan pays a large percentage of the cost of care and you pay the rest. For example, if your coinsurance is 20 percent, you’ll pay 20 percent of the costs when you need care. Your health plan pays the other 80 percent. Since your deductible resets each plan year, it’s a good idea to keep an eye on the figures. If you’ve met your deductible for the year or are close to meeting it, you may want to squeeze in some needed tests or procedures before your plan year ends to lower your out-of-pocket costs. If you have had a lot of medical expenses this year, you may have also met your out-of-pocket maximum. If that’s the case, you may not have to pay anything for in-network services covered by your plan. So you'll save even more on treatment you’ve been putting off. If you wait until your new plan year starts for the same treatment, your deductible and your out-of-pocket maximum will have reset. That means you will have to pay more out of pocket for the very same care. High Finance The end of your plan year is also a good time to review your financial paperwork. Members with employer-sponsored plans may have a Flexible Spending Account balance that needs to be used before the end of the plan year. A Flexible Spending Account, or FSA, is an employer-sponsored option that lets you set aside a part of your earnings before taxes for qualified medical expenses. Qualified expenses include doctor’s visits and products such as contact lenses and prescription glasses. Using an FSA may save you money. But pay attention to the calendar. FSA money is often a “use-it-or-lose-it” benefit. Sometimes FSA money will roll to the next plan year, but check with your benefits department to make sure. For both employer-sponsored and individual plans, a Health Savings Account is also money set aside to be used for qualified health care costs. But any money you don’t spend can be rolled to the next plan year. Find out more about flexible spending accounts and health savings accounts . Keep Smiling It’s nice to have a clean report from the dentist, no matter your age. If you think you might need to have some work done, now’s a good time to check it out. If you have a dental plan, double check your yearly maximums. If you expect to need fillings, crowns or root canals, you might want to plan them in the current plan year to use your available funds. Some people have one procedure at the end of one plan year and the next at the beginning of the new plan year to break the treatment into two different plan years. It’s an efficient, cost-effective way to use your benefits. Check Your Benefits With Ease If you have questions, there’s one place to go — your member account. You can access your account any time via the online portal or our free BCBSTX App . Your member account lets you manage your health plan online. You can get easy access to whatever information you’re looking for. Stay organized and cut the time you spend looking for paperwork. One thing to check is your deductible amounts. That’s the amount you pay on some visits and treatments each year before your health plan starts to pay. You can see an overview of your deductible information on your Dashboard. You can find more details in the Coverage section. You can also get more plan details and a new printed or digital ID card. The Claims section shows your claims for the past 18 months. It’s also where you will find your claim statements or Explanation of Benefits (EOB). The statements will show the service supplied, what your plan covers, your financial responsibility and more. You can also sort claims by date, status, provider and claim type. While you’re logged in, you can change your contact preferences under My Account. You can also search for doctors and other providers in your network by selecting Find Care. Sources: Health Checkup , U.S. National Library of Medicine, 2024; Year-End Tips to Maximize Your Health Benefits , JDRF.org, 2022Preventive CareDeductiblesBlue Access for MembersBAMSave MoneyHealth Care Costshttps://connect.bcbstx.com/understanding-benefits/b/weblog/posts/what-is-an-out-of-pocket-maximumThu, 30 Jul 2026 09:00:00 GMT6e104328-2028-43b6-bb31-8401437dc51f:406ac177-789f-4be2-ae0f-1b83cbcd13dcBCBSTX Connect TeamWe know health care terms can be confusing. One you’re sure to run across is “out-of-pocket maximum.” What does it mean? How does it affect you and your family? How does it influence your choice of health plan? You share the cost of your care with your health insurance company. You pay money to cover your deductible, copays and coinsurance (if coinsurance applies to your plan). But here’s some good news: There is a limit to how much you are required to pay. It’s called your out-of-pocket maximum (OOPM). And it is the most you’ll have to pay during a policy period – usually a year – for health care services. If you are a current BCBSTX member, you can see your plan’s OOPM on your member ID card and in online member account . It’s different for every type of plan. Here are some things to keep in mind: Your OOPM limits how much you can be charged for your health care expenses. This limit protects you if serious and expensive medical issues come up. The government can change the OOPM each year. For 2027, the highest OOPM a plan can have is $12,000 for an individual and $24,000 for families. But some plans will have a lower OOPM. Remember, if you go out of your health plan's network for services, those expenses may not count toward your OOPM, and you could have to pay more. Take this scenario for example: Joe’s plan has an $9,200 out-of-pocket maximum. That is the most Joe will pay this year out of his own pocket for covered medical expenses. Joe only pays for the medical care he uses. If he’s healthy, he may only pay for a few doctor visits and prescriptions. But if he has an accident or major illness, that accident or illness could mean costly hospital bills. But Joe has health insurance and stays in network. So he won’t have to pay more than $9,200 for covered expenses this year, even if his care costs more. Read more about a deductible vs out of pocket maximum. Before you choose a health insurance plan, it’s important to first consider a plan’s provider network. To see which providers are in a plan’s network, you can search online . If you already have a health insurance plan, log in to your account and click Find Care to find a provider in your plan's network.How Health Insurance WorksOut-of-pocket costsProvider FinderHealth Care CostsInsurance BasicsMedical Billshttps://connect.bcbstx.com/understanding-benefits/b/weblog/posts/coordination-of-benefitsTue, 28 Jul 2026 09:13:00 GMT6e104328-2028-43b6-bb31-8401437dc51f:b25bb571-29c0-48c2-8f34-1e45c610e984BCBSTX Connect TeamWhen you need care and are on two different health insurance plans, your insurers will coordinate your benefits (COB). This helps you get maximum coverage when you need it. If you’re covered by two different health plans, your provider may file the claim with both plans. The health insurers will decide which plan covers certain expenses on the claim. This is called Coordination of Benefits. If there are times when your primary plan doesn’t cover the whole claim, the secondary plan may cover them all or pay a certain amount. It depends on the COB rules. How It Works Coordination of benefits may be needed if: You are on your employer's health plan and on the plan your spouse has with their employer. You buy your own health plan, but you are also on your spouse's group plan. You and your spouse have individual policies and are listed as dependents on both. You have dependent children covered under both your and your spouse's health plan. A custody agreement requires one parent to cover the children, but both parents choose to include them on their coverage. If you have Medicare and another plan, coordination of benefits is always used. Medicare may be the primary or secondary payor. It depends on the Medicare coordination of benefits. Let your insurer know up front if you have Medicare. It will save you and your doctor time when filing claims. Why Coordination of Benefits? Coordination of benefits helps: Avoid duplicate payments so the two plans don’t pay more than the total amount of the claim. Make sure the proper payments are made by each plan. Reduce the cost of insurance premiums. You may get a form in the mail, an email or a call from your insurer to set up the coordination of benefits. You may also want to document any other coverage you have when your plan renews each year. Even if you don’t have other coverage, you'll need to let your insurer know. Sometimes claims are held until coordination of benefits is confirmed. A provider won’t be paid until primary and secondary coverage is confirmed. Want To Know More? If you have more than one health plan, check out the section of your benefit materials called Coordination of Benefits to learn how it works. For more information, call the customer service number on your health plan's member ID card. Source: Coordination of Benefits , ehealthinsurance.com, 2023; Coordination of Benefits , Centers for Medicare & Medicaid Services, 2026; How Medicare works with other insurance , medicare.govBenefits and CoverageMedical ClaimsCustomer ServiceUnderstanding Insurancehttps://connect.bcbstx.com/understanding-benefits/b/weblog/posts/reasons-claim-deniedThu, 16 Jul 2026 10:22:00 GMT6e104328-2028-43b6-bb31-8401437dc51f:e7e14367-ee71-452a-97fa-d1220e37f0d0BCBSTX Connect TeamBelieve it or not, there are only a handful of reasons that may lead to a health care service not getting approved or a claim not being paid. They fall into these five buckets. The claim has errors. Minor data errors are the most common culprit for claim denials. Sometimes, a provider may code the submission wrong, leave information out, misspell your name or have your birth date wrong. Your explanation of benefits (EOB) will give you clues, so check it first. If you find an error, ask your provider to correct the information and submit your claim again. You used a provider who isn’t in your health plan’s network. Some plans only cover care if you use providers and facilities in your plan’s network. If you go out of network, your plan may not cover any of the costs. Other plans may only cover some of the out-of-network costs, and you have to pay the difference. Your care needed approval ahead of time. Some procedures, like CT scans, MRIs and certain surgeries, usually require prior authorization. If a claim isn’t covered because it wasn’t authorized in advance, talk to the provider who ordered it. Your provider may be able to submit patient records that show you needed the service. You get care that isn’t covered. Your health plan may not provide that benefit. For example, your plan may not cover weight-loss surgery. In that case, it doesn’t undergo medical review. If your plan doesn’t cover it, the procedure won’t be approved. This is called a coverage limit or contract exclusion. If you lost health plan coverage, your claim may not be covered. This may happen if you don’t pay your monthly premiums or run out of COBRA. The claim could also be denied for a medical reason. These types of denials may include: The services are not considered medically necessary. The right level of care wasn't provided given your condition. The treatment hasn’t been proven effective or is considered experimental for your condition. The claim went to the wrong insurance company. If you have a second health plan, like one from your employer and one from your spouse’s employer, the provider may have billed the wrong company. Or your care provider may have outdated information if you changed insurers. When you get your EOB, check to see if it is from the right health plan, then contact your provider. Sources: Reasons for Health Claim Denials and What You Should Do , VeryWellHealth, 2023; What to Do When Health Insurance Won’t Pay , Insurance.com, 2023; Appealing a Health Care Decision , HealthCare.govHow Health Insurance WorksMedical ClaimsExplanation of BenefitsHealth Care CostsUnderstanding InsuranceAppealshttps://connect.bcbstx.com/understanding-benefits/b/weblog/posts/claim-not-approvedThu, 16 Jul 2026 09:32:00 GMT6e104328-2028-43b6-bb31-8401437dc51f:bffb10db-7856-4810-82bf-08c7ffd7ca16BCBSTX Connect TeamNurse care manager Lenzy Mixon got a call from a member about a large bill he received for a stay at a skilled nursing facility. He checked with his doctor, who assured him the stay had been pre-approved by his health plan. His next call was to us. Mixon said she was sure it was a mistake, so she reached out to a utilization review nurse and a customer advocate. Together, they found the error that caused the claim to be denied, adjusted the records and sent it through again for payment. “He was relieved and happy hearing that the claim was being adjusted so quickly,” Mixon said. While not every claim denial is so easily fixed, there are times a claim doesn’t get approved for reasons other than the service not being covered by a member’s health plan. Do you know what to do if a claim isn’t approved? First, Ask Why If you have a claim that isn’t approved, you can look at the explanation of benefits (EOB) for the claim to find out why. An EOB is generated for your medical claims to help you track what your insurance is covering and what amount you may need to pay, such as a copay or coinsurance. If a claim is denied, the EOB will explain the reason for the denial. Find Out Your Next Steps Do they have the wrong birth date listed for you? Is the address your doctor listed different from what we have on file? If the claim wasn’t approved because of an information error, reversing the denial may be fairly quick and easy. Call customer service at the number on your member ID card. You can give the customer advocate the right information to correct your file. If your provider’s office made the mistake, you can call the billing office to get the information corrected. If the service isn’t preauthorized or is denied for payment for another reason, you may need to ask that the claim be reviewed. This is called appealing the decision. You can appeal by phone or by mail. You, your doctor or another person you’ve named to represent you can appeal. Understand the Appeals Process There is a multi-step process in place that can help you if you think a claim has been denied in error. It is outlined in an insert included with your EOB. It is also explained in your benefit information. I f our reviewer is going to deny a service as not medically necessary, your doctor will receive a notification. That notification will include the option to schedule a call with the reviewer. Your doctor can review the case over the phone with us to try to resolve the issue. If the issue is not resolved and the claim is denied, you can appeal. A standard appeal is an internal review of your claim. You’ll call or send a letter to ask that the claim be reviewed to see if something can be done to reverse the denial. If a claim is denied for a medical reason, a medical doctor will review the claim. If a standard appeal does not resolve the issue, you can request to have a second medical reviewer look at the request. This second level of appeal is done by an outside, independent review organization. Your EOB will explain what types of denials can be sent for external review. There is no cost to you for an external review. Get Started You’ll need to provide as much information as you can to support the claim. Maybe the claim reviewer didn’t have the films from your MRI that showed you needed the surgery your doctor requested. It may be that a referral was required, and the referral wasn’t documented. The need for more information is another reason that often leads to a claim not getting approved. Medical review will require more information. For example, you may need: A letter from your doctor explaining why the requested treatment should be approved Patient notes from your treating physician on other care you have had for your condition The results of other tests or procedures related to the request Current medical articles or study results that support the treatment’s effectiveness Your own letter explaining why you believe the treatment is needed Hang in There For things like wrong information, a quick correction can be made and the claim refiled for approval. But other reviews take time. A standard appeal takes about 30 days for review for getting care pre-approved. Other appeals may take up to 60 days. These timeframes start when you file the appeal, not from the time of your treatment or from when the claim wasn’t approved. You have 180 days to file an appeal from the date the claim wasn’t approved. An external review takes about 45 days. If you qualify for urgent review, the outside review organization will give you a decision within 72 hours. You have four months from the date of your internal review decision notice to file a request for external review. Check Your EOB You should always check your EOB to make sure your claim information is correct. Every EOB has instructions on what to do if a claim has been denied. You may get your EOB in the mail. If you are signed up for paperless communications, your EOB can be found in your online account. Sources: Engaging with Insurers: Appealing a Denial , Patient Advocate FoundationHow Health Insurance WorksMedical ClaimsExplanation of BenefitsHealth Care CostsUnderstanding InsuranceAppealshttps://connect.bcbstx.com/understanding-benefits/b/weblog/posts/in-network-health-careWed, 08 Jul 2026 14:01:00 GMT6e104328-2028-43b6-bb31-8401437dc51f:46182eaf-b461-4426-841b-05ee98290bcbBCBSTX Connect TeamWhen you shop, you probably keep an eye on costs. You want to buy the things you need at a fair price. What about when you’re shopping for health care? Using providers in your health plan’s network can help you save money. A network includes hospitals, clinics, doctors, pharmacies and others who take part in your health plan. These network providers agree to work with your health plan. That helps keep your costs down. Providers who do not have a contract in place with your health plan are out-of-network . In-Network, Out-of-Network — What’s the Difference? By staying in your network, you can take advantage of discounted rates and avoid surprise charges. That’s because in-network health care providers and your health plan have agreed to a set price for each treatment or procedure in advance. A provider who is not in your plan's network can charge higher prices for the same care. You may also have to pay a higher copay or deductible for out-of-network care. In some cases, you may even have to pay the full cost. Before you go anywhere for care, make sure the provider or facility is in your health plan network. You’ll receive the same quality health care you should expect from any provider at the most affordable cost to you. Try these tips: Once you find a provider, check to see if they are in-network for your specific health plan. Simply asking if they take Blue Cross and Blue Shield insurance is not enough. Give them the information on your member ID card — including the full name of your plan — to make sure. If your primary care provider gives you a referral to another doctor, ask for one who is in your plan’s network. Then make sure that the new doctor is in your network. If you need surgery or other health services, check to make sure each facility where you will get care is in your network. It’s a good idea to see if each provider for the service or procedure is also in your network. But if you get care from an out-of-network provider while you’re at an in-network facility, you may be protected from unexpected costs, called balance billing or surprise billing. To find providers in your health plan’s network, log in to your account and select Find Care. Don’t Forget Pharmacies When you use a pharmacy that is in your network, you’ll save money. With some prescription drug plans, there can be another consideration. Along with in-network and out-of-network pharmacies, there may be a preferred pharmacy network in your plan benefits. If so, you’ll save the most money when you fill your prescriptions at preferred pharmacies. To find an in-network pharmacy, log in to your account and look under Pharmacy. On the Pharmacy page, search for retail or home delivery pharmacies. If you’ve been using a pharmacy that isn’t in-network, it’s easy to switch. You can take your prescription bottle/bag to the new in-network pharmacy. Or you can call the new pharmacy and ask them to contact your current pharmacy. You can also ask your health care provider to contact your new pharmacy. Make sure to ask your provider to send any new prescriptions to your network pharmacy. You may need to take your BCBSTX member ID card with you if it’s your first visit to the pharmacy or if you’ve changed health insurance plans. Plan in Advance Remember, whether it’s a doctor, clinic, hospital, therapist or other provider, you may pay less for care when you visit an in-network provider. That’s why it’s good to learn about your choices before you need care. It will help you be better prepared to take care of your health.Benefits and CoverageUsing Health InsuranceHealth Insurance NetworkHealth Care Costsin-networkhttps://connect.bcbstx.com/understanding-benefits/b/weblog/posts/hipaa-what-more-do-you-need-to-knowWed, 08 Jul 2026 13:14:00 GMT6e104328-2028-43b6-bb31-8401437dc51f:798d4b9b-cf20-4e32-8004-9216a640b2a1BCBSTX Connect TeamWhen you go to a doctor, dentist or eye doctor, you are asked to sign that you’ve seen their privacy statement. What does that mean? Thanks to the Health Insurance Portability and Accountability Act ( HIPAA ), you are reminded at each visit that your health information will be private and used only for making sure you get the care you need. Privacy Before HIPAA Before HIPAA, a University of Illinois study found, more than one-third of Fortune 500 companies looked at health records or health information as part of their employment decisions. Imagine worrying that a potential employer could refuse to hire you or your current employer could fire you if they found out that: You’re a recovering addict You may need to take extra time to handle your cancer treatment You have HIV, Hepatitis C, or some other health issue You receive care for mental health issues Before HIPAA, this happened. It happened to FBI agents. It happened to truck drivers. It may have happened to you or someone you know. Since HIPAA was signed into law in 1996, employers have not been allowed to see your health information. Privacy with HIPAA Have you: Been told to stand well back from the pharmacy counter? Signed a privacy form when you see a new doctor or go to a hospital? Found it impossible to get health information about a family member? Though these steps may sometimes frustrate you, they are needed to protect your health information and that of others. Things to Consider with HIPAA Your adult child . Do you have a child going off to college? If your child is 18 or over, you may not be able to receive their health information as you had in the past. If you want to know about the health care services your child receives, you’ll need to fill out an authorization form — with your child’s written permission. Helping loved ones with HIPAA . You notice an elderly family member having odd spells or memory issues. You want to know about their care and if there is anything you should be doing to help them. You’ll need an authorization or a power of attorney for health care from your family member before you can help. Completing one of these documents ahead of time can reduce the stress when an issue happens. Your spouse has a serious illness . Cancer, ALS, renal failure. These and other health problems can get critical fast. Make sure you can make decisions that will honor their wishes. Maybe they want to donate their body to science or to be an organ donor. Maybe they want a Do Not Resuscitate order on file. Be sure to complete the necessary forms so you can make or enforce those decisions if your spouse isn’t able to. Privacy laws like HIPAA have made a difference in making sure your health problems are kept private. Make sure you know how they work and what you may need to do if you want others close to you to know more.HIPAAStandard AuthorizationPHIUnderstanding Insurancehttps://connect.bcbstx.com/understanding-benefits/b/weblog/posts/virtual-visits-annual-examsWed, 08 Jul 2026 09:13:00 GMT6e104328-2028-43b6-bb31-8401437dc51f:6987b8f3-f247-4d6e-856c-1a899752aa64BCBSTX Connect TeamDoes your health plan offer telemedicine visits with doctors in your plan’s network? Now's a good time to check. It may be just what you need to stay on top of your health. During the pandemic, more health care facilities turned to telemedicine visits to help keep patients and staff safe. And telemedicine visits remain a good option for things like: New health concerns Annual exams Routine check-ins on health issues When There’s a Problem Having stomach issues? A headache that won’t go away? A rash that concerns you? These are the types of issues you may see your primary care doctor about. To do so, you usually have to schedule a visit and go to the office. But a hands-on exam may not be necessary. Instead, the doctor may simply offer helpful medical advice, prescribe a medicine or send you for a test. This is the type of visit that can often be handled just as well with a telemedicine visit. If your plan includes behavioral health care, a telemedicine visit is also a good opportunity to talk to your doctor about depression, anxiety or other mental health issues. Annual Exams Some primary care doctors, pediatricians and women’s health providers may also choose to do annual exams using telemedicine visits. These visits play a big role in catching small health problems before they become big ones. Doctors are finding that much of what they do in your yearly checkup can be done virtually: Review your health and family history Update a list of your current medicines Talk about your lifestyle Discuss tobacco and alcohol use, diet and sleep habits Other exams and tests can be scheduled separately. Blood tests, vision and hearing exams and imaging like mammograms are good examples. Your doctor can also send prescriptions directly to your pharmacy. As always, an annual exam is covered at no cost to you if you see a provider in your health plan’s network. Condition Check-ins Chronic health conditions like diabetes, asthma, heart disease and cancer need your attention every day. It’s vital that you keep your appointments, follow doctor’s instructions and let your care provider know if you have concerns. An added benefit of telemedicine visits is that you don’t have to arrange travel or time off from work or school. How Telemedicine Doctor Visits Work Depending on your health plan’s benefits, a telemedicine visit with a doctor in your plan’s network may be covered. Signing up for a telemedicine visit is easy: Make sure you have internet access and a smartphone, tablet or computer with a built-in or attached camera. Call your doctor’s office to ask about telemedicine visits and schedule an appointment. Be sure to ask if the provider is in your health plan’s network. You may need to handle paperwork and any payment before the call, either online or by email. When it’s time for your appointment, follow the instructions from the doctor’s office on how to connect with your doctor. Virtual Visits, powered by MDLIVE ® Telemedicine visits are covered under many Blue Cross and Blue Shield of Texas health care plans. Some BCBSTX health plans also include access to Virtual Visits*, powered by MDLIVE ® . This service gives you access to board-certified doctors and licensed behavioral health therapists for many non-emergency health situations. Log in to your online account to see if you have the Virtual Visits benefit. Go to My Health then Find Care. If you see Virtual Care, click there to see your telemedicine options. If you have Virtual Visits, you will see instructions for how to register and schedule an appointment. *MDLIVE is a separate company that operates and administers Virtual Visits for Blue Cross and Blue Shield of Texas. MDLIVE is solely responsible for its operations and for those of its contracted providers. MDLIVE and the MDLIVE logo are registered trademarks of MDLIVE, Inc., and may not be used without permission. Virtual Visits may be limited by plan. For providers licensed in New Mexico and the District of Columbia, Urgent Care service is limited to interactive online video; Behavioral Health service requires video for the initial visit but may use video or audio for follow-up visits, based on the provider’s clinical judgment. Behavioral Health is not available on all plans.Benefits and CoverageVirtual VisitsAnnual ExamTelemedicinehttps://connect.bcbstx.com/understanding-benefits/b/weblog/posts/fitness-program-waived-enrollmentMon, 06 Jul 2026 08:15:00 GMT6e104328-2028-43b6-bb31-8401437dc51f:748a0159-2a63-4b3e-82d1-fe180b5fc7edBCBSTX Connect TeamWell onTarget, the Fitness Program and Blue Points SM are not available to all members. Check your online account information or ask your benefits administrator to see if you have these benefits. If you’re looking to stay in shape, or get back in shape, now is a good time to join the fitness program. The $19 enrollment fee will be waived for eligible new members who sign up now through Aug. 31, 2026.* Join today and get access to a nationwide network of participating facilities so you can work out whether traveling, at home or at work. You can also choose digital options like online fitness videos and live classes. Enjoy All the Fitness Program Benefits The Fitness Program offers flexible plan options ranging from $19 to $239 a month. You can select a plan option that best suits your lifestyle. You’ll have access to all locations available in the plan you choose, as well as locations in any of the lower-priced plan options. Digital fitness options are also included in all plans at no cost. The Digital Only plan is $10 per month. Choose from thousands of digital fitness videos and live classes. More Fitness Program Features Real-time check-in and activity reporting information is provided through the Well onTarget Fitness Program mobile app and Well onTarget portal. Get Complementary and Alternative Medicine (CAM) discounts through Choices by Whole Health Living.** Save money through a nationwide network of 40,000 health and well-being providers such as acupuncturists, massage therapists and personal trainers. To take advantage of these discounts, register at wholehealthliving.com . Go online to find fitness locations and track visits. Get the Well onTarget Fitness Program Mobile App You can use the Well onTarget Fitness Program app to: Have real-time check-in and activity reporting Explore nearby locations in the Fitness Program network Get easy access to your Fitness Program membership card Download the Well onTarget Fitness Program app free of charge from the Apple and Android app stores. Search for “Well onTarget Fitness Program.” Be sure to register in the Fitness Program portal before you start using the app. After you’ve registered, you can log in to the Well onTarget Fitness Program app using your Fitness Program portal username and password. Join Now To get the waived fee, use coupon code AUG26FP when you enroll. To enroll, log in to your Blue Cross and Blue Shield of Texas member account , go to the My Health drop-down menu and select Wellness . Then scroll down to Fitness Program . You can decide on the plan that best meets your needs and select the fitness location that is best for you. Remember to enter the coupon code AUG26FP during enrollment before Aug . 31 to get the waived fee. You can also enroll by calling 888-762-BLUE (2583) Monday through Friday, between 7 a.m. and 7 p.m. CT (6 a.m. and 6 p.m. MT). *After Aug . 31, 2026, regular enrollment fees will apply to all new memberships. This offer can’t be combined with any other promotional offers. ** Choices by WholeHealth Living benefits are not offered in Oklahoma and Montana. The waived enrollment promotion is only available to members with the Fitness Program, which is included in the Well onTarget ® program. Individuals must be 18 years old to purchase a membership. Dependents 16 to 17 years old can join but must be accompanied to the location by a parent/guardian who is also a Fitness Program member. Check your preferred location to see their membership age policy. Underage dependents can log in and join through the primary member’s account as an “additional member.” Member agrees to comply with all applicable federal, state and local laws, including making all disclosures and paying all taxes with respect to their receipt of any reward. The Fitness Program is provided by Tivity Health TM , an independent contractor that administers the Prime Network of fitness locations. The Prime Network is made up of independently owned and operated fitness locations. No endorsements, representations or warranties are made regarding third-party vendors and the products and services offered by them.Benefits and CoverageExerciseWell onTargetFitness Programhttps://connect.bcbstx.com/understanding-benefits/b/weblog/posts/trouble-premium-paymentMon, 29 Jun 2026 16:50:00 GMT6e104328-2028-43b6-bb31-8401437dc51f:0d040f44-2e3c-4d27-870e-de69d4bbcb65BCBSTX Connect TeamWe encourage members to make payments by electronic funds transfer and to set up monthly premium payments using Auto Bill Pay electronic funds transfers. When you’re first getting started, using electronic funds transfer helps us process your enrollment quickly. And throughout the plan year, auto payments help make sure your payments are on time without you having to worry about it. Using auto bill pay lowers your risk of losing coverage due to nonpayment of monthly premiums. Our member payment portal experience is designed for quick and easy use. But what can you do if you’re having trouble getting your payments set up? Here are a few common issues and tips that may help you fix them. If your payment set-up is not going through: Recheck for errors. Typos often happen with both number and letter entries. And autocorrect may sneak in an incorrect spelling before you copy and paste. Try a different payment method. Using a different credit card or bank account may help. Banking institutions can have system outages that keep your payment method from going through. And sometimes other electronic bills come through sooner or later than expected, keeping your payment set up from going through. If your payment is not appearing on your bank statement: Check the auto bill pay specifics: Double check the date of your first auto draft or the next date of the auto draft. Look to see where your payment is in the process during the end of the month draft (see status indicator). Remember that it can take up to 24 hours for the bank to show the draft in your account. If you’ve checked for these common issues and are still having trouble, call the number on your member ID card. A customer service representative will be happy to help you complete the process.Benefits and CoveragePay Premium PaymentsIndividual and Family Coveragehttps://connect.bcbstx.com/understanding-benefits/b/weblog/posts/preventive-or-medicalTue, 09 Jun 2026 00:10:00 GMT6e104328-2028-43b6-bb31-8401437dc51f:85eaadfa-d45a-4b98-a551-39276627435cBCBSTX Connect TeamMany people may not know that there are two types of care you can receive when you go to the doctor — preventive care and medical care. The type of care is different, and your costs may be different, too. Medical Care vs. Preventive Care Think about how people use health care based on their needs. A person with a chronic disease may need to see a doctor or specialist often. Others may have occasional injuries or infections. Treatment of disease and injury is considered medical care. So What Is Preventive Care? Proper diet, exercise and healthy lifestyle can all help avoid certain health problems. Preventive care does the same thing. Preventive screenings can help catch problems early, before you notice symptoms. Yearly preventive exams and screenings may include: A physical exam Screenings for things like blood pressure and cholesterol levels Vaccines you need to prevent illness Mammogram screening Colon cancer screening Cervical cancer screening Diabetes screening Sometimes Preventive Care and Medical Care Cross Paths There are both “screening” and “diagnostic” versions of many tests , such as mammograms and colonoscopies. A screening version is considered preventive care. Preventive screenings are usually ordered at certain ages and at regular intervals when there is no reason to suspect a problem. If a person has symptoms or anything looks unusual on a screening test, then they may need a diagnostic test, which is considered medical care. Diagnostic tests take a closer look to see if disease is present. The technology for screening and diagnostic (medical) tests may be similar. But where and when you take them and who reads the results are different. The out-of-pocket costs may also be different. It’s a good idea to find out what your out-of-pocket costs will be before you schedule your appointment. Check with your doctor’s office to see which kind of test you’ll be getting. And check your benefits or call the customer service number on your member ID card to get the details about your coverage and costs for the test. Why Fix What Isn’t Broken? Even if you feel healthy, once a year you should get a preventive checkup from your doctor. Preventive care may help you avoid some health problems, or find health problems early, when your chances for treatment and cure are better. A preventive checkup is worth your time and effort because: It can catch disease early and may lead to better health outcomes and lower costs. Six in 10 American adults have a chronic disease. Four in 10 have four or more chronic diseases. These diseases are a leading cause of death and disability in the U.S. These conditions are preventable or treatable in many cases. Preventive screenings can find very early signs of a condition, when simple changes in diet and daily habits may reduce the risk or even reverse it. Our qualified* health plans cover most preventive health care services with no out-of-pocket costs when you go to your primary care provider or medical group (for some HMOs) or a doctor or medical center in your plan’s network (non-HMO plans). You pay no copay or coinsurance even if you haven’t met your deductible. You can find complete details of the preventive services your plan covers in your benefit book. To make sure a provider or facility is in your plan’s network, log in to your account online or through the BCBSTX App and go to Find Care. *Preventive services at no cost applies only to members enrolled in non-grandfathered health plans. You may have to pay all or part of the cost of preventive care if your health plan is grandfathered. To find out if your plan is grandfathered or non-grandfathered, call the customer service number on your member ID card. Sources: Chronic Disease , Centers for Disease Control and Prevention; Fast Facts: Health and Economic Costs of Chronic Diseases , CDC, 2025; About Chronic Diseases , CDC, 2026Preventive CareBenefits and CoverageMedical Carehttps://connect.bcbstx.com/understanding-benefits/b/weblog/posts/blue365-time-to-saveMon, 08 Jun 2026 16:49:00 GMT6e104328-2028-43b6-bb31-8401437dc51f:fb22ccec-21f4-440d-b8e4-53c14504ddd9BCBSTX Connect TeamIf you’re looking for some great discounts on health-related products and services, check out the Blue365 ® program. It’s just one more advantage of being a Blue Cross and Blue Shield of Texas member. You and your covered family members can save with top retailers on products and services that may not be covered by insurance. There are no claims to file and no referrals or prior authorizations needed. Find Deals You Like You can find deals in six main categories: Apparel and Footwear Fitness Hearing and Vision Home and Family Nutrition Personal Care Some examples of discounted products and services you may find include: Outdoor clothing, athletic shoes and fitness products Gyms, classes and wearable devices Glasses and contacts Dental services, vitamins and supplements, and wearables Weight loss programs and meal delivery services Mindfulness classes and products and services that support mental wellness and reducing stress Start Saving To start saving, log in to the Blue365 site . If you don’t already have an account, it’s easy to create one . Be sure to have your BCBSTX member ID card handy when setting up your account. When you log in, you’ll see all the deals available to you. When you find a discount you like, click on details . You may get a coupon code that you can apply directly to your purchase on the vendor’s site. Or you may be sent to the vendor’s site, and the discount will have already been applied for you. Deals change often, so if you see one you like, don’t wait to take advantage of it. Blue365 is a discount program only for Blue Cross and Blue Shield of Texas members. This is NOT insurance. Some of the services offered through this program may be covered under your health plan. You should check your benefit booklet or call the Customer Service number on your member ID card for specific benefit facts. Use of Blue365 does not change monthly payments, nor do costs of the services or products count toward any maximums and/or plan deductibles. Discounts are only given through vendors that take part in this program. BCBSTX does not guarantee or make any claims or recommendations about the program’s services or products. You should consult your doctor before using these services and products. BCBSTX reserves the right to stop or change this program at any time without notice. Hearing services are provided by Start Hearing, Great Hearing Benefits, HearUSA and TruHearing ® . Vision services are provided by ContactsDirect ® , Croakies, Davis Vision SM , EyeMed Vision Care, Glasses.com, Jonathan Paul Fitovers, and LasikPlus ® . The relationship between these vendors and Blue Cross and Blue Shield of Texas is that of independent contractors.Benefits and CoverageBlue365DiscountsSave Moneyhttps://connect.bcbstx.com/understanding-benefits/b/weblog/posts/travelers-checklist-protect-your-health-while-you-travelThu, 21 May 2026 14:07:00 GMT6e104328-2028-43b6-bb31-8401437dc51f:ffb22feb-d580-4dc5-8473-673b2d8faf28BCBSTX Connect TeamVacation sounds good right about now. And whatever kind of vacation you like, there’s one thing that makes it go better – planning. Planning helps your road trip skip the bumps in the road. Planning helps you avoid turbulence, even once your plane has landed. A good first step as you plan your trip is to make sure you have health care that travels with you. Whether you’re taking a road trip or catching a plane, you don’t want sickness or injury to be part of your trip. Before you start to pack, take steps to be prepared. Double check that you have health insurance for where you're going, so you can get the help you need if something does happen. Do Your Research Don’t travel without access to your health plan information. Make sure you set up your online account account before you pack your bags. You can access coverage information, look for providers in your network and more in your account. If you're traveling domestically, you can make a list of the in-network doctors and/or hospitals near where you will be staying. This will save you time and worry if you or one of your family members gets sick. And if you or a family member has a serious, chronic health issue, be sure to talk to your doctor before your trip. There may be additional issues to consider. To find doctors and hospitals in your network, log in to your account online or through the BCBSTX App and go to Find Care . Bring Your Member ID Card Make sure you pack your member ID card. Bring along a photocopy in case you lose it. You will have to show your member ID card at the doctor's office, clinic or hospital if you need health care services. Many providers will allow you to show them a digital copy of your member ID card. You can access your digital ID card by logging into your member account or with the BCBSTX App. Pack Your Medicines and Copies of Your Prescriptions If you are taking prescription drugs, pack enough to last you the whole trip and extra in case of delays. The U.S. Department of State recommends that you leave your drugs in their original, labeled container. Pack them in your carry-on bag if you are flying. Be sure to bring copies of your prescriptions. Going Abroad? See if Your Coverage Travels with You Check your benefits to see what coverage you have when you are away from home. You may want to consider getting additional coverage if you're traveling outside of the U.S. Learn more about international coverage options. Need Shots? Talk to your doctor at least six weeks before your trip to allow time for any recommended or required vaccinations. Discuss your specific travel destinations and what shots you’ll need. Many take time to be effective. Some must be given in a series. While you’re there, make sure all your routine shots are up to date. The Centers for Disease Control and Prevention has a list of recommended shots for children and adults. Know Where You’re Traveling To stay safe, do your research and heed local warnings. Before you leave, stay informed about travel conditions abroad by checking the CDC's Travel Health notices. You’ll find up-to-date news and travel warnings about current health issues linked to specific destinations. These issues may spring from disease outbreaks, special events, natural disasters or other conditions that may affect travelers’ health and safety. Heading Home As you plan your trip, make sure you know what will be required to come back to the States. There are things you may have to do before you can get on a plane or leave the airport, from having your temperature taken to taking a test for a virus or disease. And travel from some countries back to the U.S. may be banned because of contagious disease outbreaks, including measles, malaria and yellow fever. Sources: Vaccines & Immunizations , Centers for Disease Control and Prevention; Medicine and Health: Your Health Abroad , U.S. Department of State, 2025PrescriptionsHealth Insurance NetworkImmunizationsUnderstanding InsuranceTravelingID cardhttps://connect.bcbstx.com/understanding-benefits/b/weblog/posts/good-fit-doctorMon, 04 May 2026 18:57:00 GMT6e104328-2028-43b6-bb31-8401437dc51f:b26f5af0-19ee-4dcc-a719-c308420aeaa4BCBSTX Connect TeamSometimes you know it’s time for a change. But what if that change involves finding a new primary care doctor? Maybe you’ve moved, and it’s a long drive to your current doctor. Perhaps you’ve had changes in your health or lifestyle. Or you just think it would be better to find someone new. No matter what the reason, you’re ready to act. Some change is hard, but this one doesn’t have to be. Here’s where to start. Take the First Step Your first step is to log in to your member account. You’ll find your coverage details, access resources and tools, and more. You can also learn more about your benefits and access member services. Once you have logged in to your account, go to Find Care to search for network providers in your area. You can search for a doctor by location, medical specialty and more. Remember, if you visit a doctor who is not in your network, you may have to pay more for your care. Sometimes, you may have to pay the full cost. If your health plan is an HMO, there may be special steps for changing doctors. Check your benefits book or call the customer service number on your member ID card if you have questions. Don’t Wait Don’t wait until you're sick to find a personal doctor. That might be an internal medicine doctor or one in family practice. For a woman, it might be an OB-GYN. Or you can select a pediatrician for your child. Remember to visit your primary care doctor for routine care. You may save money by seeing your regular doctor for the flu, minor aches and sprains, and other health issues instead of going to an urgent care clinic or emergency room (ER). There are times when using a walk-in retail health clinic or urgent care center is a good choice. Make sure you only use the ER when there’s an emergency. Start Building Once you’ve picked your new doctor, help your doctor give you the best care by always being open and honest. Asking questions also improves the quality of care you receive. Ask about recommended tests and treatments. Ask questions any time you don’t understand something. One way to build a relationship with your doctor is to schedule a yearly exam. That’s the time to talk to your doctor about your health, risk factors and family medical history to find out what health screenings you need each year. Getting the right preventive health services, screenings and treatments improves your chances of living a longer, healthier life. Build a Relationship with Your Doctor. Your Body Will Thank You There are benefits to regularly seeing the same doctor. The more your doctor knows about you, the better your care will be. Open communication is easier with someone you know. How to Choose When you’re ready to select a doctor, first narrow your choices. Then research the doctors you’re thinking about online or call doctors’ offices to get more information. Be sure to choose a provider who is in your network . Here are some questions the American Academy of Family Physicians suggests you ask: Are they in-network for your health plan? Do they take new patients? What are office hours? Do they have on-call hours? How long does it take to get an appointment with the doctor? What hospital does the doctor use? How many doctors are in the practice? Do they do lab tests in the office? When you find a doctor you want to check out, make an appointment and prepare for the visit. The doctor will need to know your health history and the medicines you take. And tell the doctor about upcoming events that could affect your health, such as travel. After your first appointment, think about your visit. Were you comfortable with the doctor and the office staff? Did they answer your questions? If you feel good about the visit, you may have found your new doctor. Sources: Are You Up to Date on Your Preventive Care? , Centers for Disease Control and Prevention, 2025; Patient Rights , American Medical Association; Choosing a Family Doctor , Familydoctor.org, 2025; Talking With Your Doctor or Health Care Provider , National Institutes of Health, 2025Benefits and CoverageDoctor Patient RelationshipBlue Access for MembersFind a Doctorhttps://connect.bcbstx.com/understanding-benefits/b/weblog/posts/wheres-my-coverage-health-screenings-for-menMon, 04 May 2026 10:26:00 GMT6e104328-2028-43b6-bb31-8401437dc51f:62f616ff-51bf-4dac-a628-3d3428edd1cdBCBSTX Connect TeamYou’re a healthy guy. You eat right and exercise. You’ve never even had a cavity. So you may think it’s no big deal to skip an annual wellness check. But not so fast. Preventive screenings are important for your health. Screenings help find hidden health problems early, before you have symptoms and when they are easier to treat. If you have insurance, your health plan covers a number of preventive screenings* at no cost. That means you won’t have to pay anything when you go for your exam. The type of screening tests you may need depend on your age and other risk factors. Use this guide to learn about the screening tests that are important for men to have for a long and healthy life. A Guide to Top Risks and How to Prevent Them Cancer Every year, more than 325,000 men lose their lives to cancer. The five most common cancers for men are skin, prostate, lung, bladder and colorectal. The facts drive home why regular screenings are so important. Talk to your doctor about which ones are best for you and how often you need them. After skin cancer, prostate cancer is the most common cancer in American men. It mostly turns up late in life and has a wide range of treatments. For men aged 55 to 69 years, the decision to get regular screenings for prostate cancer should be an individual one, according to the U.S. Preventive Services Task Force. You should discuss your risks with your doctor and decide on the best plan of action for you. Colorectal cancer is the second leading cause of cancer deaths in the U.S. of both men and women. A screening can find precancerous growths called polyps so they can be removed before turning into cancer. If cancer is found, early treatment is effective in preventing death. Do you smoke? Talk to your doctor about your lung health, and about ways to quit. Lung cancer is the No. 1 cause of cancer death in both men and women in the U.S. Counseling for quitting smoking may be covered by your plan. Aids to help you quit, like nicotine patches, may be covered, too. Check your benefits. If you’re over the age of 45, it’s time to get serious about cancer screenings. If some types of cancer run in your family, talk with your doctor about being screened earlier. Based on your results, your doctor will let you know when you should be screened again. High Blood Pressure A blood pressure check by a health professional is easy and painless — and important. High blood pressure (also called hypertension) is the single biggest risk factor for heart disease, stroke, kidney disease and other health problems. High blood pressure usually doesn’t have warning signs or symptoms. Checking your blood pressure is the only way to find out if you have it. Have yours checked regularly. If your blood pressure is high, or you have certain risk factors, your doctor may suggest more frequent checks. Talk with your doctor about ways to keep yours in check. High Cholesterol A simple blood test will let you know if your cholesterol levels are within a healthy range. If yours is high, you have a higher risk for heart disease and heart attack. As with high blood pressure, high cholesterol often doesn’t have symptoms. Men over 35 should get their cholesterol tested regularly. If you are at risk for heart disease, a doctor may advise you to start earlier. Family genetics, your own medical history of heart issues, and the amount of stress in your life are some of the risk factors. Type 2 Diabetes If you have high blood pressure or a family history of Type 2 diabetes , be proactive and get tested for the disease. Without proper management, Type 2 diabetes can lead to other serious health issues. In fact, people who don’t know they have Type 2 diabetes have a much higher risk for stroke and heart disease. Depression Your mental health is just as important as your physical health. If you feel sad and hopeless for more than two weeks, talk with your doctor about a screening for depression . Depression often gets worse if left untreated. Get Started This isn’t a complete list of all the preventive tests often covered by health plans at no charge to you. A good place to learn more about which screenings are right for you is a visit with your primary care provider. Schedule a yearly exam and talk about screenings and a preventive care plan tailored to your health needs. *Preventive services at no cost applies only to members enrolled in non-grandfathered health plans. You may have to pay all or part of the cost of preventive care if your health plan is grandfathered. To find out if your plan is grandfathered or non-grandfathered, call the customer service number on your member ID card. Sources: Cancer Facts & Figures 2026 , American Cancer Society, 2026; Key Statistics for Prostate Cancer , American Cancer Society, 2026; Prostate Cancer: Screening , U.S. Preventive Services Task Force, 2018; High Blood Pressure , American Heart Association; About Cholesterol , Centers for Disease Control and Prevention, 2024; Type 2 Diabetes , CDC, 2024; Can Colorectal Cancer Be Prevented? , American Cancer Society, 2025; Measuring Your Blood Pressure , CDC, 2024; Lung Cancer Statistics , CDC, 2025; Lung Cancer Basics , American Lung Association, 2026Preventive CareBenefits and CoverageMental HealthHealthy LivingCancerMen’s Healthhttps://connect.bcbstx.com/understanding-benefits/b/weblog/posts/estimate-costs-and-find-doctors-hospitals-with-provider-finderMon, 04 May 2026 08:00:00 GMT6e104328-2028-43b6-bb31-8401437dc51f:63a7884c-2912-4e2a-9537-56b16df9d57dBCBSTX Connect TeamMany of us compare prices before we buy a product or service. It’s one of the best ways to be an informed consumer. But we might not think about comparing prices when it comes to our health care benefits. And that’s a missed opportunity because it could save quite a bit of money. If we want the most value for our health care dollars, a little research can make a big difference. It’s no surprise that costs can vary greatly depending on where you go for care. For example, the cost of an MRI might vary between $613 and $6,304 – depending on the provider. Knee replacements can range from $23,445 to $47,389. And higher cost doesn’t always mean better quality. By doing some research before you get care, you may be able to lower your out-of-pocket costs. Cost sample amounts compiled from allowable in-network cost data for providers within a 50-mile radius of Dallas, Texas. Costs are examples and may not apply to every member’s situation. Be a Smart Health Care Consumer We offer tools to help you make your health care choices. You can: Find a doctor or hospital in your health plan's network. Compare costs* for different providers. Estimate the cost for procedures, treatments and tests. View patient feedback and add your review for a provider. Review providers’ certifications and recognitions. To use these tools, log into your account and go to Find Care . Don't have an account yet? Get set up with a few easy steps. Once you're registered, you can log in to your account. Or you can use the BCBSTX App. The app is available in English and Spanish for iPhone and Android users. Download the BCBSTX App today. *Cost estimates are not available for all plans. Before you schedule a diagnostic imaging procedure, your plan may require that you call a Benefits Value Advisor or Health Advocate. If your plan does require that you contact a BVA or HA, your out-of-pocket costs may be higher if you do not call. Please see your plan documents for details. Cost estimates are just an estimate. In addition to your usual deductibles, copays and/or coinsurance, the actual cost of the services may vary based on a number of factors including the date of service, the actual procedure performed, what services were billed by the provider and your particular benefit plan. Coverage is subject to the limitations and exclusions of your plan.How Health Insurance WorksBlue Access for MembersProvider FinderHealth Care CostsInsurance BasicsFind a DoctorUnderstanding Insurancehttps://connect.bcbstx.com/understanding-benefits/b/weblog/posts/work-together-with-doctorFri, 10 Apr 2026 18:52:00 GMT6e104328-2028-43b6-bb31-8401437dc51f:0a5b0fda-5206-4408-a0bd-3b33f85bb9e3BCBSTX Connect TeamWhen you need medical care, do you have a doctor you can call? If not, find a doctor you can call your own. Don’t wait until you’re sick to become a patient. If you have an HMO* or POS** plan, you’ll need to find a primary care provider, or PCP, to be your “personal” doctor. A PCP most often focuses on general internal medicine, family medicine or obstetrics/gynecology (OB/GYN). Older adults can choose a geriatric doctor. Children can have a pediatrician. The Power of Teaming Up with Your Doctor Here are five ways having a PCP can benefit your health and well-being. Someone to quarterback your care : Having your own personal doctor means you’ll have someone in your corner making sure you get the care you need. They’ll know your health history, any health conditions you have and what medicines you take. More focus on staying healthy: Your doctor will provide your routine medical care such as annual exams and treatment for colds and the flu. They will also make sure you get vaccinations and screenings and talk with you about how your lifestyle might impact your health. That way you can focus on staying healthy, instead of seeking help only when you are already sick or hurt. A trusted guide to your follow-up care: Your doctor can guide you to the best place to go when you need more care. If you need to be seen by a specialist, they can coordinate the care, especially if you need to be seen by more than one. This keeps your care on track and can help you avoid unneeded visits. Detect and treat illness earlier: Early diagnosis and treatment can keep many common health problems from getting worse. Having your doctor manage your care means problems can be caught early before they become serious or lead to other major illnesses. For example, catching high blood pressure early and getting it under control could prevent you from having a stroke later. Manage your conditions and care better: If you have a chronic health issue such as asthma, diabetes or a heart problem, your doctor can make sure you have access to specialized care to help keep your condition from getting worse. Personal Care. Simplified. To make the most of your relationship with your PCP and get the most out of your health plan, follow this advice: Schedule that first visit now: If you’re choosing a new doctor as your PCP, schedule your first visit as soon as possible. The sooner you create a relationship with your doctor, the sooner you’ll have someone in your corner overseeing your care. And going to your new patient appointment right away will help avoid delays in getting an appointment when you’re sick or need a referral. To each, their own PCP: Each person on your plan can pick their own PCP. Your PCP’s name and contact information will be listed on your member ID card. If you decide later your PCP isn’t right for you, you can choose a different one. See your PCP first: It’s best to call or go to your PCP first when you need care unless it’s an emergency. Your PCP will be able to make informed choices and direct you where you need to go for further treatment. That may mean going in to see your PCP or a specialist, going to an urgent care center, or heading to an emergency room. If you need to be seen by a specialist such as a cardiologist, make sure to start with your PCP. It’s important to get your care from providers in your network. This will help ensure you have fewer out-of-pocket expenses. Depending on your type of plan, if you get care from a provider who is not in your plan’s network, you may have to pay the full cost of your care. To make sure a provider or facility is in your plan’s network, log in to your account and go to Find Care . You can search for the provider and location that is right for you. Depending on your plan, you may also be able to estimate the out-of-pocket costs for your tests or treatments. *HMO is the commonly recognized term that refers to a Health Maintenance Organization. **POS is the commonly recognized term for a Point-of-Service plan.Primary Care ProviderBenefits and CoverageDoctor Patient RelationshipFind a Doctorhttps://connect.bcbstx.com/understanding-benefits/b/weblog/posts/breast-pumpsThu, 09 Apr 2026 18:22:00 GMT6e104328-2028-43b6-bb31-8401437dc51f:ba728b4f-1ab7-45f4-92cb-73a10e78e952BCBSTX Connect TeamNourishing your newborn baby is one of the most important things you’ll do as a parent. Breastfeeding is a popular option for many parents — and for good reasons. Breast milk provides ideal nutrition that supports a baby’s growth and development. The Center for Disease Control and Prevention (CDC) reports it lowers an infant’s risk for ear infections, asthma, Type 1 diabetes, obesity and sudden infant death syndrome (SIDS). Anytime, Anywhere Convenience Along with important health benefits, breastfeeding does away with the need to mix formula or prepare bottles. It makes on-the-go feeding easy. Also, when traveling it can give comfort to babies when their normal routine has been disrupted. Breast pumps play a vital role in this flexibility. Pumping and storing breast milk allows both parents and others to share in feeding duties and increases your supply of breast milk. When you need to be away from your baby, there is a supply of milk ready to go. Blue Cross and Blue Shield of Texas covers a variety of breast pumps for members whose health care plan includes this benefit. If you have a Flexible Spending Account, you can use your FSA dollars toward any out-of-pocket costs for a breast pump. Which Breast Pump Is Right for You? Every pump is designed with a shield that covers the breast and a container that collects milk. There are some basic variations, though. Before choosing, you’ll want to do a little research to learn about your options. Manual breast pumps don’t require batteries or electricity. Instead, the pump is worked by hand so it can be used anywhere. A manual pump is best for parents who don’t need to pump a lot of milk at one time. Electric pumps have a motor that uses electricity or batteries. They come in single- and double-pump models. Single-pump models collect milk from one breast at a time. Double-pump models can collect milk from both breasts at the same time. Many parents who attend school or work away from home choose double pumps because they work faster and are more convenient. Hospital (or Medical)-grade breast pumps have a more powerful motor for better suction. They are typically used in a hospital setting. The purchase cost of these pumps isn’t usually covered by a health plan. However, they can be rented by the month for home use. Hospital-grade breast pumps are usually only recommended for: Moms who have trouble establishing their milk supply Parents with premature babies, babies with health issues that may impact feeding, or those infants in the NICU Parents of multiple babies Things to Keep in Mind You may not know how often you’ll need to pump until your baby arrives. Your third trimester is a good time to consider ordering your breast pump to ensure you have it before the delivery of your baby. If you’re not sure what kind of pump is best for you, talk with a trained breastfeeding counselor. The U.S. Department of Health and Human Services’ Office on Women’s Health also offers helpful information about breastfeeding , including Your Guide to Breastfeeding , which you can download to refer to when you have questions. We’re Here to Support Parents BCBSTX benefits help support families as they prepare for their new baby . We offer breastfeeding support, counseling and supplies through our maternity benefits. You’ll find a lot is covered by your health insurance plan when you use an in-network provider — even manual and electric breast pumps . Let Us Help You Find a Breast Pump To get started on getting a breast pump, call the number on your member ID card or send a secure message through your member account online . Our Customer Advocates can tell you: If your plan covers a breast pump. If it does, ask if both electric and hospital-grade models are covered. Some plans cover both an electric pump and the rental of a hospital-grade pump up to a certain dollar amount. Other plans may only cover one type of pump. Be sure to ask if there will be an out-of-pocket cost and what that cost may be. Full coverage may only apply to certain models of breast pumps. If your health plan requires a prescription for a breast pump. Which in-network providers or durable medical equipment (DME) suppliers in your network and state offer breast pumps and how to contact them. Depending on your health plan, your benefits may include Women and Family Health. The program offers access to a nurse case manager who can help you find breast pumps and connect you with other breast-feeding resources. Sources: Breastfeeding Benefits Both Baby and Mom , Centers for Disease Control and Prevention, 2025; How to Use a Breast Pump , WebMD, 2025; What to Know When Buying or Using a Breast Pump , U.S. Food and Drug Administration, 2023; Breastfeeding , American Academy of Pediatrics, 2024Benefits and CoverageWomen’s HealthPregnancyInfant Carehttps://connect.bcbstx.com/understanding-benefits/b/weblog/posts/how-to-save-moneyThu, 02 Apr 2026 19:08:00 GMT6e104328-2028-43b6-bb31-8401437dc51f:00ffb0bd-619c-42c9-b449-e45c9693bf01BCBSTX Connect TeamNo one likes to pay for health care. But we need health care to help us stay healthy, manage health conditions and get care when we need it most. Health insurance protects us from the financial burden of unexpected medical costs. There are a few ways to help lower your out-of-pocket costs. Read on to learn how you can save on doctor visits, prescription medications, fitness equipment and more. Stay Healthy with Preventive Care The best way to save money on health care costs is to stay on top of your health with preventive care. We can’t always avoid illness, but we can do our part to protect our health with annual exams, health screenings and staying up to date on immunizations. It all begins with scheduling an annual visit with your primary care provider . At the visit, you will talk with your doctor about your health history and any changes you may be noticing. You can also find out what screenings are right for you and if you’re due for any vaccines. Visit an In-Network Provider to Save Money Your health plan gives you access to many kinds of health care providers like doctors, therapists, clinics, pharmacies and hospitals. Before you go for care, make sure a provider is in your health plan network. Those who are contracted to provide care for you and other family members in your health plan are called network providers . They may also be called in-network providers or participating providers . Providers who do not have a contract with your health plan are out of your network . To find providers in your network, log in to your account online or through the BCBSTX App and go to Find Care . Then follow these tips to help keep your costs down. Save on Prescription Medicine There are a few easy ways to save on your prescription medicines: By filling your Rx at an in-network pharmacy for your health insurance plan, by checking your plan’s drug list, and by discussing your options with your provider or pharmacist. Preferred Pharmacy Savings If a preferred pharmacy network is part of your benefits, you’ll save the most money when you fill your prescriptions at one. When you use a preferred pharmacy, you pay the lowest out-of-pocket cost on covered prescription drugs. Some medicines have copays as low as $0 at preferred pharmacies. If you need a 90-day supply, you can get it at preferred pharmacies or by home delivery. Learn how to find an in-network pharmacy. Prescription Drug List A drug list is a list of drugs that are covered under your prescription drug benefit. How much you pay out of pocket is determined by whether your drug is on the list and at what coverage level, or tier. A generic drug is often at the lower tier. See if your drug is covered . Some prescription drug plans may require you to pay more if you fill a prescription for a brand name drug when a generic equivalent is available. Members are encouraged to use drugs that are safe, work well and are cost effective. Learn more about pharmacy and prescription plan coverage here. Ask your provider or pharmacist if there are any lower-cost alternatives for your prescription. A generic or lower-tier brand drug may be right for you. Treatment decisions are always between you and your provider. Get Member Perks Blue365 ®* Any member of a participating Blue Cross and Blue Shield plan is eligible for Blue365, a free health and wellness discount program offered to members. You and your covered family members can save with top retailers on products and services that may not be covered by insurance. There are no claims to file and no referrals or prior authorizations needed. Discounts fall into six categories: Apparel and footwear, fitness, hearing and vision, home and family, nutrition, and personal care. Learn how to create an account and save with Blue365. *Blue365 is a discount program only for Blue Cross and Blue Shield of Texas members. This is NOT insurance. Some of the services offered through this program may be covered under your health plan. You should check your benefit booklet or call the Customer Service number on your member ID card for specific benefit facts. Use of Blue365 does not change monthly payments, nor do costs of the services or products count toward any maximums and/or plan deductibles. Discounts are only given through vendors that take part in this program. BCBSTX does not guarantee or make any claims or recommendations about the program’s services or products. You should consult your doctor before using these services and products. BCBSTX reserves the right to stop or change this program at any time without notice. Hearing services are provided by Start Hearing, Beltone TM , HearUSA and TruHearing ® . Vision services are provided by ContactsDirect ® , Croakies, Davis Vision SM , EyeMed Vision Care, Glasses.com, Jonathan Paul Fitovers, and LasikPlus ® . The relationship between these vendors and Blue Cross and Blue Shield of Texas is that of independent contractors.PrescriptionsMember RewardsBenefits and CoverageBlue365Save MoneyProvider FinderHealth Care Costs