HealthSelect - BlueCross BlueShield Provider Network

HealthSelect - Blue Cross Blue Shield Provider Network

ERS wants your doctor to be in the HealthSelect network. BCBSTX is actively focused on building the network. Even with more than 58,000 providers and growing, it is important to note that network negotiations are not finished. Your doctor may be talking with BCBSTX now or could be in the near future.

BCBSTX is especially focused on primary care physicians (PCPs) – such as family physicians, pediatricians, ob/gyns and internists – specialists and hospitals.

We fully expect more providers to join the HealthSelect network as we near September 1. The process can take time. We appreciate your patience while it’s underway.
ERS does not get involved in contract negotiations between BCBSTX and providers. ERS contracts with BCBSTX to deliver a quality provider network to HealthSelect participants. Contracting with health care providers can be complicated and, in many cases, takes time. ERS is heavily involved in activities that are appropriate to achieve a quality network and a quality health plan overall. 
Both BCBSTX and ERS are aware of these areas, and BCBSTX is paying special attention to them as it builds the network. It’s important to remember that provider negotiations can take time. Even if it seems like nothing’s happening, there might be productive discussions taking place. 

If there are still network issues in a region on September 1, members can ask for a network gap exception. A network gap exception means your and/or your dependents’ providers maybe treated as in-network if there is not a similar provider within a certain distance:
  • If the closest in-network PCP (family physician, pediatrician, ob/gyn and/or internist) is more than 30 miles from your address on file with ERS, you can request a network gap exception. 
  • If the closest in-network specialist is more than 75 miles from your address on file with ERS, you can request a network gap exception to treat your specialist as in-network.
  • It's important to keep your address on file with ERS up to date. You can update your address online at any time, most days.
    • You can use your home or work address to decide your health insurance benefits. Whichever address you choose to use must be the one on file with ERS. 
  • You can get more information about network gap exceptions, or beginning September 1, 2017, request an exception by calling a BCBSTX Personal Health Assistant toll free at (800) 252-8039, Monday-Friday, 7 a.m. - 7 p.m. CT, and Saturday, 7 a.m. - 3 p.m. CT.
ERS and BCBSTX want your doctor to be in the HealthSelect network, and are working for that to happen. But if your doctor is not in the network by September 1, 2017, you have the following options:
  • If you already have a referral for specialist who is in UnitedHealthcare’s HealthSelect network, but not in BCBSTX’s HealthSelect network, that referral will be valid for up to 90 days after September 1, 2017 or the referral end date, whichever is sooner. Visits to specialists that fall within this timeframe will be treated as in-network. 
  • If you are currently getting ongoing treatment from a doctor who will not be in the HealthSelect network on or after September 1, you may be able to continue treatment with your doctor temporarily and receive in-network benefits. This is called “transition of care.” To qualify for transition-of-care benefits, you must meet certain eligibility guidelines.
    • Medical conditions that may be eligible for transition-of-care benefits include: pregnancy in the second or third trimester; long-term treatment of cancer, heart disease or transplants; and terminal illness if life expectancy is less than six months.
    • If you are approved for transition of care, in-network benefits may be available for up to 90 days after September 1, 2017. After that, your level of benefits will be decided by BCBSTX.
    • The transition-of-care form is available online or by calling a Personal Health Assistant.
  • BCBSTX has a large number of “par plan” providers who can help protect you against balance billing. That means you will not pay the difference between the par plan provider allowed charge and the amount you are billed (known as “balance billing”).
    • Par plan providers are still out of network, but they agree to not balance bill you. 
    • It is possible that your current doctor may be a BCBSTX par plan provider, even if he or she is not in the BCBSTX HealthSelect network. To find a list of par plan providers, visit the provider finder and scroll to the bottom of the page. Click on the box titled “Find a doctor, hospital or other provider in the HealthSelect Secondary network” to be taken to the network search tool for the BCBSTX par plan. Or call a BCBSTX Personal Health Assistant toll free at (800) 252-8039, Monday-Friday, 7 a.m. - 7 p.m. CT, and Saturday, 7 a.m. - 3 p.m. CT.
  • If there are no in-network PCPs or specialists in your area, you can request a network gap exception. Please see Question 3 for more information on network gap exceptions.
  • The HealthSelect plans allow out-of-network benefits, but you will pay more of the overall cost. Please see the Plan Year 2018 Health Plan Comparison Chart, available on the Health Benefits webpage for information on costs for out-of-network care in HealthSelect.
  • Nominate your doctor, so that BCBSTX can work to get him or her in the network.
    • You can submit a nomination form any time on the BCBSTX website. Or you can call a BCBSTX Personal Health Assistant toll free at (800) 252-8039, Monday-Friday, 7 a.m. - 7 p.m. CT, and Saturday, 7 a.m. - 3 p.m. CT.
    • Please note that nomination does not guarantee that the provider will be accepted into the network. It may take up to 90 days for the provider to be accepted into the network.
Use the provider finder on the HealthSelect website. Be sure to click on your plan/ benefit structure – HealthSelect of Texas, Consumer Directed HealthSelect, HealthSelect Out-of-State or HealthSelect Secondary – to access the right network information. You also can call a BCBSTX Personal Health Assistant toll free at (800) 252-8039, Monday-Friday, 7 a.m. - 7 p.m. CT, and Saturday, 7 a.m. - 3 p.m. CT. 

Please keep in mind that many doctors, facilities and hospitals are in the BCBSTX HealthSelect network, but some have not completed their network status yet and can still be added. Check the site frequently.
We are not contracting for an HMO plan. While we do not discuss the specifics of contracts between BCBSTX and their contracting providers, we want to make sure the providers’ questions are answered correctly. If your doctor’s office has questions about the contract, the doctor’s office should contact the BCBSTX Provider Relations Department. 

It is important for you to know that, with BCBSTX as administrator, HealthSelect of Texas will still be a point-of-service plan, designed especially for State of Texas employees and their families. As a point-of-service plan, it has both in-network and out-of-network benefits. HealthSelect of Texas is not becoming an HMO.
As of mid-July, BCBSTX has contracted with 58,000 providers to be in the HealthSelect network. It is not unusual during a change like this to have some contracts complete quickly and for others to take a bit longer. Because the network process is not finished, information changes daily. We encourage you to check the online provider finder often, or to call a BCBSTX Personal Health Assistant as we near September 1. Personal Health Assistants are available toll free at (800) 252-8039, Monday-Friday, 7 a.m. - 7 p.m. CT, and Saturday, 7 a.m. - 3 p.m. CT.

BCBSTX is a highly regarded company that manages health plans covering millions of participants. The company administered HealthSelect of Texas for decades before 2012. When choosing BCBSTX, the ERS Board of Trustees and staff looked at a number of traits that contribute to successful health plan administration, not just cost. ERS is dedicated to providing high-quality health coverage at a reasonable cost.