Staying In-Network Is Important

Staying In-Network Is Important

Staying In-Network Is Important

You want to take care of yourself. So, it's good that when you need health care services, you have a whole network you can tap. Your health plan gives you access to many kinds of care providers. Doctors, therapists, clinics, pharmacies and hospitals are all ready to help.

Before you go for care, make sure the provider is in your health plan network. Health professionals who have agreed to give care to you and other members in your health plan are called network providers. They may also be called in-network providers or participating providers. 

Those without a contract to provide care are out-of-network providers.

It’s important to know the difference. By staying in the network, you can take advantage of lower rates and avoid surprise charges. In-network health providers and your Medicare plan have agreed to a set price for each treatment or procedure.  

Someone who is not in the network can charge higher prices for the same care. You may also have to pay a higher copay or deductible for out-of-network care. Depending on your type of Medicare plan, out-of-network care may not be covered. Or it may only cover part, not all, of the full amount.

Follow these tips to stay in your network and keep your costs down: 
  • Use the BCBSNM Provider Finder® tool online to see what doctors, hospitals and urgent care centers are in your Medicare plan’s network.  
  • Call the number on your BCBSNM member ID card and ask if a certain doctor or provider is in your network. 
  • Once you find a doctor, ask if they are in-network. Simply asking if they take Blue Cross and Blue Shield of New Mexico is not enough. The doctor may not be in your specific Medicare plan’s network. Give the doctor the information listed on your card, including the full name of your plan.  This will help them identify what your plan offers.   
  • If you ask your primary care doctor for a referral to another doctor, ask for one who is in your Medicare plan’s network. It is important that you make sure that the doctor is also in-network.  
  • If you need surgery or other health services, make sure each provider who will care for you is in your Medicare plan’s network.  

Out-of-network providers are under no obligation to treat Blue Cross Medicare Advantage members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services. 

Important Plan Information

Originally published 3/12/2019; Revised 2021, 2024