How to Find Blue Cross Blue Shield In-Network Doctors

Anthem Blue Cross Blue Shield Medicare Advantage plan beneficiaries may be restricted to using their benefits with a Blue Cross Blue Shield in-network doctor. It depends on the type of plan you have – such as an HMO or a PPO Medicare Advantage plan – and the type of care you need.

If you’re looking for an Anthem Blue Cross Blue Shield Medicare Advantage (Medicare Part C) plan that covers your doctors, you can compare plans and their provider networks online or by calling to speak with a licensed insurance agent.

In this review, we take a look at the Blue Cross Blue Shield network of doctors and other health care providers and what this means for you as a beneficiary.

How Can I Find a Blue Cross Blue Shield In-Network Doctor?

Blue Cross Blue Shield makes it easy to find in-network health care providers. Current plan members can use the online BCBS find-a-doctor online lookup tool to search for in-network providers in your area including doctors, dentists, hospitals and more. 

What Is a Blue Cross Blue Shield In-Network Doctor?

A Blue Cross Blue Shield in-network doctor is one who accepts Blue Cross Blue Shield health insurance and agree to adhere to the terms, conditions and reimbursements set forth by the plan’s coverage. The provider also needs to accept Medicare patients.

Blue Cross Blue Shield in-network doctors can include (but are not limited to):

• General practitioners
• Nurses
• Specialists
• Labs and lab technicians
• Pharmacies and pharmacists
• Hospitals
• Rehab facilities
• Clinics and urgent care centers
• Dentists and eye doctors
• Suppliers of medical equipment and supplies

When Should I Use a Blue Cross Blue Shield In-Network Doctor?

Some plans are more restrictive to the Blue Cross Blue Shield network than others, but it’s generally a good idea to visit an in-network provider whenever possible. 

• If you have an HMO plan, you are unlikely to receive any coverage if you visit an out-of-network doctor or other provider except for emergency care. 
  
  
• If you have a PPO plan, you can often receive some coverage for care when visiting an out-of-network provider, but your out-of-pocket costs for covered services will typically be lower when seeing a Blue Cross Blue Shield in-network provider. 

One exception is with Blue Cross Blue Shield Medicare Supplement Insurance (Medigap) plans. These plans do not adhere to a network and are accepted anywhere that Original Medicare (Part A and Part B) is accepted. Please note that Medicare Advantage and Medicare Supplement plans are very different, and you can’t have both types of coverage at the same time.

What Is HMO Insurance?

An HMO, or Health Maintenance Organization plan, restricts members to the plan’s network of participating providers. If you stray outside of this network for care, you are unlikely to receive any coverage and, in most cases, will be responsible for the full cost of the service or item out of your own pocket.

Emergency care services is the lone exception and is covered at the same plan rate as non-emergency care. 

HMO plans generally practice “managed care,” which is when a primary care physician coordinates your care within the plan’s network of specialists and issues referrals for care.  

What Is PPO Insurance?

PPO, or Preferred Provider Organization, is a type of plan that allows members to visit doctors and other providers outside of the plan’s network and still receive at least partial coverage in most cases. However, plan coverage will typically be maximized when staying inside the network for care.

PPO members may still have a primary care physician but are not dependent on them for referrals and their care is not coordinated the way it is with an HMO plan.  

Like HMO plans, emergency care is not restricted to network use with a PPO plan.  

Is Blue Cross Blue Shield The Same As Anthem?

Anthem is one of the largest providers of health insurance in the U.S. and owns a number of subsidiary companies. Blue Cross Blue Shield is one of those subsidiaries. 

The Anthem Blue Cross Blue Shield brand name is used in the following states:

• California
• Colorado
• Connecticut 
• Indiana
• Kentucky
• Maine
• Missouri
• Nevada
• New Hampshire
• Ohio
• Virginia
• Wisconsin 

To learn more about your Medicare Advantage plan options and to look for Anthem Blue Cross Blue Shield Medicare plans that cover your doctor, request a free plan comparison online or call to speak with a licensed insurance agent.