Have an upcoming procedure or diagnostic test?

Have an upcoming procedure or diagnostic test?

October 3, 2017

Avoid surprise medical bills and delays with these tips.

If you’ve ever had minor surgery, you had pre-operative instructions to remember, transportation arrangements to make, and possibly childcare to arrange. However, estimating your out-of-pocket costs and taking steps to prevent delays in your surgery may have come as an afterthought that you regretted. 

If you are enrolled in HealthSelectSM of Texas, administered by Blue Cross Blue Shield of Texas (BCBSTX), the most important steps you can take to minimize your costs, avoid surprise medical bills and prevent delays for specialty care/tests are to:

  • use only facilities/providers (including anesthesiologists and other hospital-based providers) in the HealthSelect network,
  • have referrals to specialists in place before your visit (does not apply to HealthSelectSM Out-of-State and Consumer Directed HealthSelectSM) and
  • have prior authorizations for the procedure/test approved before receiving that service.

Use this checklist before receiving specialty care and tests (such as diagnostic imaging or lab work):

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If you need care or a service your in-network primary care physician (PCP) cannot provide, your PCP should refer you only to in-network specialists.

You can find out whether a specialist is in the HealthSelect network by calling a BCBSTX Personal Health Assistant (PHA) at (800) 252-8039. You can also go to https://HealthSelectofTexas.com and click on Find a Doctor/Hospital, then click on the Search box for your plan..

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If your PCP refers you to an in-network specialist, make sure your referral is in place before your scheduled visit.  If the referral is not in place by the time of your visit, you may need to reschedule your visit. Referrals typically expire in 12 months. (HealthSelectSM Out-of-State and Consumer Directed HealthSelectSM participants do not need referrals to specialists.)

You can check the status of your referral by calling your specialist’s office or a BCBSTX PHA, or you can go the HealthSelect of Texas website and log in to Blue Access for Members, the BCBSTX secure member portal. Click the Log In button on the far right side of the screen. You can register if you haven’t already done so.

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Before undergoing a procedure that involves multiple providers, such as anesthesiologists or assistant surgeons, make sure those providers are in the HealthSelect network.

Even if you are using an in-network facility or hospital, an out-of-network provider may be on the care team. Ask the doctor who is performing the procedure to give you the names of all other providers involved in your procedure, so that you can check their network status.

To find a list of HealthSelect of Texas in-network, hospital-based physicians by region, you can go to: https://HealthSelectofTexas.com/content/find-a-doctor-hospital/index. Remember to click on the box that represents your plan:

  • HealthSelect of Texas
  • Consumer Directed HealthSelect
  • HealthSelect Out-of-State
  • HealthSelect Secondary

Also, please keep in mind that some doctors, facilities and hospitals have not completed their network status yet and may still be added to the HealthSelect network. The website is updated regularly as more providers join the network.

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For tests and procedures not performed in your network doctor’s office, make sure the facility is in-network.

Your doctor may not know if a preferred facility is in the HealthSelect network. To find out if the facility where your procedure is scheduled is in-network, call a BCBSTX PHA or go to  Healthselectoftexas.com and click Find a Doctor/Hospital (see above).

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For certain tests and procedures, your doctor may need to complete a prior authorization with the plan.

It's a good idea to call the provider/facility or a BCBSTX PHA (or log in to the Blue Access for Members secure portal) before your scheduled test/procedure to find out if a prior authorization is required and to check the status of the prior authorization. If the prior authorization is not in place by the time of your visit, you may need to reschedule your visit until prior authorization is approved by BCBSTX.

Estimating network costs and understanding when your payments are due:

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Estimate your network costs by calling a BCBSTX PHA or logging into your Blue Access for Members HealthSelect account and using the Cost Estimator tool.  

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Ask your provider for a copy of the cost estimates for the procedure or test before your scheduled visit so that you aren’t surprised by your medical bills. Talk to your provider to learn when and how you will be expected to pay your portion of the bill (or bills).

Remember: If you’re in HealthSelect Out-of-State or Consumer Directed HealthSelect, you don’t need a PCP or referrals to specialists. But you still can save money – sometimes a lot of money – by seeing providers in the HealthSelect network.

Handy Tools

BCBSTX, the administrator for HealthSelect as of September 1, has tools you can use to get the care you need while avoiding surprise medical bills and unnecessary delays.