All about networks

All about networks

Whether you are already a member or about to become one, it's important to know that BlueCross is the most recognized and accepted health plan in the nation. With a BlueCross ID card in hand, you can easily get access to all the services and benefits that your plan provides. It's coverage designed to give you more value, security, and opportunities for better health.

Know your Blue Network

There are four distinct networks for PPO coverage, called Blue Networks. Each has a different grouping of doctors, hospitals and other health care providers. Your PPO plan includes one Blue Network (P, S, K or C).

The doctors, hospitals and health care facilities that participate in Blue Networks have agreed to accept lower fees for their services. These discounts let your health plan cover a larger portion of the claims submitted on your behalf.

To find out which Blue Network you're in (P, S, K or C), check the top part of your Benefits Summary or your member ID card. The one-letter name shows your health plan's specific network of providers.

Then check the online directory to search for providers in your specific network and area.

Using your Blue Network

A PPO plan allows you to visit any doctor or hospital you choose, but:

  • Using providers that are in your specific network (choosing "in-network" care) means you'll receive the highest level of benefits and pay less out of your own pocket for care
  • Using providers that are outside your network (going "out of network" for care) means you'll pay more out of your own pocket.

In addition, when you use providers in your Blue Network, you get more in return:

  • No claims paperwork to fill out
  • Better provider knowledge of your plan requirements
  • Available care 24 hours a day, seven days a week

When making an appointment, be sure to ask if the provider participates in your plan's specific BlueCross BlueShield of Tennessee Blue Network (P, S, K or C). Consider changing to providers that participate in your plan's Blue Network if your current health care providers are not in it.

When you need care

Whenever you seek care, follow these basic guidelines:

  • Always carry your member ID card and show it each time you request services from a network provider. Your ID card shows any copay amounts, if applicable, and your plan's network.
  • Call 1-800-565-9140 for prior authorization of services if needed. (If you are a new member in a group plan, call the number provided by your employer.) Your Benefits Summary and Evidence of Coverage list the services that must be authorized before they are performed in order for your health plan to cover them.
  • Go directly to the nearest hospital in an emergency. Show your member ID card at an emergency room if you have a health care crisis. Emergency care is covered anytime, anywhere.*
  • Call Customer Service within 24 hours if you are admitted to the hospital. After a prior authorization review, BlueCross will work with your doctor to coordinate your care and make the most of your health care benefits.

* Some exclusions apply.

Page Modified:May 18, 2012