How We Choose Providers for Our Networks

Ensuring Member Access Across the State

We check the locations of all health providers in all of our networks to make sure our members have access to in-network providers. It is very important to verify benefits of each network. This includes the networks for the following plans:

  • Blue Choice PPOSM
  • Blue Advantage HMOSM
  • Blue Advantage PlusSM HMO
  • Blue Cross Medicare Advantage PPOSM
  • Blue Cross Medicare Advantage HMOSM
  • Blue EssentialsSM
  • HealthSelect of Texas®
  • Blue PremierSM
  • Blue Premier AccessSM
  • MyBlue HealthSM
  • Blue High Performance NetworkSM

BCBSTX wants to ensure providers are available and accessible to members. We may use member experience, quality or cost-related measures to choose providers for some of our networks.

Medical Providers

BCBSTX works to contract with providers that offer services in all areas of medicine, including:

  • Family Practice
  • General Practice
  • Chiropractic Practice
  • Internal Medicine
  • Specialty
  • Subspecialty
  • General and specialty surgery
  • Rehabilitation

Behavioral Health Providers

These in-network providers offer service for the following:

  • Psychiatry
  • Clinical Psychology
  • Licensed Clinical Social Work
  • Licensed Counseling, including Clinical Counseling and Marriage and Family Therapy

*This is not a complete list of provider specialties.

Your BCBSTX plan may use a tiered network. BCBSTX may place providers into tiers such as:

Tier 1: Members get the highest level of benefits and pay the lowest out-of-pocket costs
Tier 2: Members get a reduced level of benefits and pay higher out-of-pocket costs

How BCBSTX Chooses Hospitals

We check the locations of all hospitals in all of our networks to make sure our members have access to in-network hospitals. It is very important to verify benefits of each network. This includes the networks for the following plans:

  • Blue Choice PPO
  • Blue Advantage HMO
  • Blue Advantage Plus HMO
  • Blue Cross Medicare Advantage PPO
  • Blue Cross Medicare Advantage HMO
  • Blue Essentials
  • HealthSelect of Texas®
  • Blue Premier 
  • Blue Premier Access
  • MyBlue Health
  • Blue High Performance Network

BCBSTX wants to ensure hospitals are available and accessible to members. We may use member experience, quality or cost-related measures to choose hospitals for some of our networks.

 

 

Last Updated: July 21, 2023