Making Insurance Work For You

How Your Health Care Plan Works

Planning ahead can help you save money when it comes to your health. Take full advantage of your health care plan with these helpful tips:

• Stay in the network. Most health plans, like HMOs and PPOs, use certain groups of doctors, hospitals and other health care professionals called provider networks. If you visit a doctor outside of your network, you may have to pay more for your care. In some cases, you may have to pay the full cost. The same could be true about where you go for infusion drug care.
• Stay in the pharmacy network. Just as important as making sure that your doctor is in your network before making an appointment, you’ll save money if you visit an in-network pharmacy. If you have prescription drug benefits with BCBSMT, learn more about your pharmacy network.
• Know what's covered. Make sure services or treatments are covered before you schedule them. If you have a PPO, you may need pre-authorization (pre-notification) from BCBSMT before you get certain tests or services. You or your doctor must call the pre-authorization (or pre-certification) number on the back of your member ID card to confirm. BCBSMT regularly evaluates the use of new and existing medical technologies. This allows us to make decisions about what's covered. It also ensures that you have access to safe and effective care.
• Understand health insurance costs. Health insurance costs can be confusing. Knowing what premiums, deductibles, copayments and out-of-pocket maximums are and how they all work together can help you understand your plan.
• Utilization Management (UM) Program Description. The Utilization Management (UM) Program description defines the structure of the UM program for BCBSMT. Utilization management is part of our Wellbeing Management Program that supports a holistic approach to address members chronic or complex conditions and promotes member and provider satisfaction through coverage and access to affordable, quality healthcare. UM preauthorization and predetermination reviews are completed using evidenced based guidelines to deliver fair, impartial and consistent determinations that can be easily interpreted by members and providers with timely decisions to accommodate the clinical urgency of the member's situation. Learn more about the UM Program

Where Your Health Plan Works

You can help control your health care costs while at home or during travels. Here are ways to keep costs down whenever you need care:

• Build a relationship with your primary care provider (PCP). Your PCP will help you stay up-to-date with annual exams and will know who you are if you call with non-emergency questions. Also, your PCP can refer you to a specialist. Remember, it's easier to get an appointment if you're already a patient with your PCP.
• Use the ER for emergencies only. When your injury or illness is serious, call 911 or go to the nearest emergency room. You don't need a referral. If it's not an emergency you may be able to save money by seeing your regular doctor for colds, minor sprains and other less serious conditions.
• You're covered away from home. Always carry your member ID card with you at all times, especially when you're traveling. If you have a life threatening injury or illness when you're traveling, go to the nearest hospital. Please note that if the hospital is out of network, your costs may be higher. If you have questions before getting care, call BCBSMT at 1-855-258-8471.

Find A Network Provider

Use Provider Finder® or call the Customer Service number on the back of your member ID card. If you need emergency care, call 911 or seek help from any doctor or hospital right away.