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Find A Doctor Or Hospital In Your Network.
This article is intended for members enrolled in an individual health insurance plan.
Your PCP is usually familiar with specialists in the area. Your doctor also may refer patients to certain hospitals, clinics or labs.
So why do we say members should shop for care? If your PCP has certain providers he or she wants you to go to, doesn’t that mean you’re questioning your PCP’s instructions if you ask for other options? Technically, yes. But doctors expect questions. They also know as well as you do that health care costs are rising.
However, your PCP may not know specifics about the cost of the hospital, clinic or lab where he or she is sending you. The tests, labs and procedures can vary significantly for the same service in the same area. So considering a cheaper option can make a big difference for your budget. You may want to let your PCP know that the share of the costs you pay out-of-pocket can squeeze your monthly budget if you are given more costly tests and procedures.
Your PCP’s priority, like ours, is your care. Your PCP would rather you get the tests or services that you need than put them off or skip them because money is tight. That is true even if you decide to get those tests or services done somewhere that may not be your PCP’s usual choice.
Giving you options is a big reason that Blue Cross and Blue Shield of New Mexico offers Provider Finder®. This online tool can show you more detail about doctors and procedures than you may realize.
Log in to Blue Access for MembersSM (BAMSM), go to the Find Care tab, then Find a Doctor or Hospital.
You can also compare costs for medical services. You can estimate the cost of up to 1,500 procedures, treatments and tests.
Click Estimate Costs to search for such things as, such as “mammogram” or “MRI of the brain.”
You will see cost breakdowns, including how your copay or coinsurance applies to your deductible and out-of-pocket maximum for most networks. If you have chosen a less cost-effective provider, you will see a “Cost Alert” at the bottom of the screen. This will show you value options and how they compare to your choices. If we see a way for you to save hundreds or even thousands of dollars while still getting the care that you need, we can tell you.
In addition to doing your Provider Finder research, it is always best to call providers before making appointments to confirm details. Make sure that they are part of your plan network and provide whatever test or service you need.
If you comparison shop and find less expensive options for the care your doctor prescribes, what should you do next?
1. Ask Your Doctor to Change Your ReferralEven if you’re uncomfortable asking about the cheaper option, it’s worth it to talk it through with your doctor. It is always important to ask questions when discussing a new test or service with your doctor. You need to make informed decisions, and cost is a significant factor. Your doctor should hear what questions or concerns you may have.
2. Be HonestYou may not think your doctor needs to know about anything but your symptoms. But your financial health can affect how or if you can follow your doctor’s orders. Whether it’s from struggling to make ends meet or trying to understand a diagnosis or procedure, stress from any source can affect your health in ways your doctor may be able to help with. Sharing that information with your doctor may help you better comply with care instructions and help your overall health.
3. Share Provider Finder ResultsShare the cost information you find on Provider Finder with your doctor. Your doctor’s preference or opinion may not change. But they may consider the results you find and agree to a more cost-effective option.
Make It Work for You
Originally published December 30, 2019; Revised 2021
Blue Cross and Blue Shield of New Mexico, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association
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