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This article is intended for HMO members enrolled in an employer health insurance plan.
All non-emergency specialty care must be approved in advance by your PCP. Your PCP will provide a referral for specialist visits, tests and other services. And any follow-up care must be coordinated by your PCP.
You don’t need a referral for mammograms or OB/GYN and behavioral health services if the providers are in your HMO network.
If you decide to see specialist or another health care provider for non-emergency care without getting preauthorization, you may be responsible for all charges.
For more information, call the customer service number on your member ID card.
The No Surprises Act offers protection in some cases from balance billing and surprise billing.
Emergency Services: The law protects members from balance billing in some emergency service situations.
Professional Services: The law protects members from balance billing in some situations where the hospital or facility might be in-network, but the provider isn’t.
Air Ambulance Services: The law protects members from balance billing in some situations when air ambulance transport was required and was received from an out-of-network provider.
Learn more about how this new federal law affects your health insurance plan.
Make sure all of your providers are in your network. You can use the online Provider Finder® tool or call the customer service number on your member ID card.
Originally published 11/18/2019; Revised 2022
Blue Cross and Blue Shield of Oklahoma, 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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