If you're looking for a health plan that's easy to understand, easy to use and easy on your wallet, an HMO may be just what you need for you and your family.
-
- Home
- Find Care
- Shop Plans
About Our Plans
Individual and Family
Dental & Vision
Life & Disability
- Prescription Drugs
Pharmacy and Prescription Plans
Pharmacy
- Insurance Basics
Understanding Health Insurance
How Health Insurance Works
Coverage Information
Importance of Health Insurance
- Member Services
Member Resources
Account Access
Quick Links
Policy Documents
Forms
New Member
- Employers
- Producers
- Providers
- Company Information
What Is an HMO?
If you're looking for a health plan that's easy to understand, easy to use and easy on your wallet, an HMO may be just what you need for you and your family.
It's Care. Simplified.
An HMO is designed to keep costs low and predictable. With one doctor to coordinate your care, an HMO health plan is easy to use and may be just what you’re looking for.
An HMO health plan offers:
- Monthly premiums, copays and deductibles are often lower than other types of plans.
- Access to certain doctors and hospitals, called your HMO provider network, which helps control how much you pay for health care.
- A primary care provider (PCP) who you see for routine check-ups, physicals, colds and flu. Your PCP will refer you to a specialist for more serious illnesses.
HMO. It's Personal.
An HMO health plan is designed so that you have care personalized to you. Your care is coordinated by one doctor who knows you — your health history, current issues and medication, lifestyle and how your family's health history may affect your health.
Getting Started
When you first sign up for an HMO health plan, you choose, or are assigned, a PCP. Each person on your plan can pick their own PCP. PCPs typically focus on general internal medicine or family medicine. Women and girls can choose an OB/GYN or a Woman's Principal Health Care Provider (WPHCP) as their PCP. Older adults can choose a geriatric doctor. Children can have a pediatrician as their PCP.
If you're a member, you can find your PCP or your medical group listed on the front of your Blue Cross and Blue Shield of Oklahoma member ID card or by logging in to Blue Access for MembersSM.
How do I know if a provider is in my network?
To make sure a provider is in your plan's network, search our Find Care tool. If you're a BCBSOK member, register or log in to BAMSM, your secure member website, for a personalized search based on your health plan and network.
- If you're a new patient, see your PCP right away. When you make your first appointment, let the doctor's office know that you're a new patient.
- Get a referral. If you need to visit a specialist, behavioral health care provider or hospital for non-emergency services, your PCP will refer you to one. Make sure the specialist or behavioral health care provider is in your network. Women don't need a referral to see your in-network WPHCP.
- Call when you need care. Your PCP should be your first stop when you need care. Please call their office or after-hours phone number for any health care needs. In emergency cases, they may have you go to the hospital.
- For real emergencies. If your illness or injury is life-threatening, call 911 or go to the nearest emergency room. You don't have to stay in-network or get a referral. Just let your PCP know that you had an emergency as soon as you can so they can follow your treatment and manage any follow up care needed.
Can I Change my PCP?
Of course! You can change your PCP or medical group/IPA at any time unless you are hospitalized or in the 2nd or 3rd trimester of pregnancy.
- To change doctors within the same medical group: Search our Find Care tool to find doctors in your medical group. Then, call the medical group (MG/IPA) on your BCBSOK ID card and ask to change doctors.
- To change to a different medical group: call the Customer Service number on your BCBSOK member ID card.
HMO. It's Affordable.
HMO health plans are designed to control costs through preventive health care that helps you avoid serious and costly health problems. Your costs are also kept low because the doctors and hospitals in the HMO provider network agree to offer their services at a set price.
The HMO network may include care and services from:
- Doctors
- Hospitals
- Clinics
- Pharmacies
- Labs
- Imaging centers
- Medical equipment vendors
In most cases, your HMO health plan won't cover any of your expenses if you go to a provider who is not in your network.
It's Personal.
An HMO health plan is care personalized to meet your needs. Your primary care doctor, or PCP, gets to know you, your health history and your family’s health history and how it may affect your health. Think of them as your personal care doctor.
When you first sign up for an HMO health plan, you choose, or are assigned, a primary care physician (PCP). Each family member on your plan can have their own PCP. PCPs can be doctors who practice:
- Family medicine
- OB/GYN
- Geriatrics
- Pediatrics
Your PCP is listed on the front of your Blue Cross and Blue Shield of Oklahoma (BCBSOK) member ID card or you can find it when you log in to your Blue Access for MembersSM account.
You can change your PCP at any time, except if you are hospitalized or in the 2nd or 3rd trimester of pregnancy.
Online
- Log in to Blue Access for Members
- Choose the Change PCP link
- Follow the instructions
It's Coordinated.
HMO health plans are designed to help you stay healthy. Having one health care expert — your PCP — to coordinate all your health care needs keeps your costs and your health on track. An early diagnosis and treatment can keep many common health issues from getting worse.
Year after year, BCBSOK HMO health plans have proven to help improve member health results and lower their overall cost of care because health issues are managed before they get serious. People with chronic conditions such as asthma and diabetes have seen the greatest results.
Working with Your PCP
Think of your PCP as your personal care doctor. Follow these guidelines to make the most of your relationship:
- Make Your First Appointment. If you're a new patient, see your PCP right away to help avoid delays later when you are sick or need a referral. Let the doctor's office know that you're a new patient.
- Get a Referral. If you need to see a specialist, test or procedure, your PCP will refer you to a provider. Make sure the provider is in your network. You don't need referrals for mammograms, OB/GYN and behavioral health services, as long as they are in the HMO network.
- In addition, you will need a referral to visit a hospital for non-emergency services. You can search for participating hospitals and providers in Provider Finder to see who is covered in your network.
- For Non-Emergencies. See your PCP first for minor illnesses like a cold, flu, minor cuts or burns. If the office is closed, call the doctor's after-hours number. They will either try to fit you in or refer you to another doctor or clinic. In some cases, they may have you go to the hospital.
- For Emergencies. For life-threatening illnesses or injuries, call 911 or go to the nearest emergency room. You don't have to go in-network or get a referral. But do tell your PCP about your emergency as soon as you can so they can follow your treatment and manage any follow-up care.
It's Affordable.
HMO health plans are designed to control costs through preventive health care that helps you avoid serious and costly health problems. Your costs are also kept low because the doctors and hospitals in the HMO provider network agree to offer their services at a set price.
The HMO network may include care and services from:
- Doctors
- Hospitals
- Clinics
- Pharmacies
- Labs
- Imaging centers
- Medical equipment vendors
To avoid getting big bills, make sure you stay in the HMO provider network. If you go outside of the HMO network, in most cases, your HMO health plan won't cover any of your expenses. This is because providers set their own prices for their services, which can vary by a few hundred to thousands of dollars. Because out-of-network providers don't have a contract with us, we can't control how much they charge you.
Find In-Network Providers
To make sure a provider is in the HMO network, search our online directory. If you’re a BCBSOK member, log in to Blue Access for Members for personalized results based on your health plan and network. This find care tool also has a cost estimator to help you find costs for health visits, procedures, surgeries, diagnostics and imaging, vaccinations/immunizations and other services.
Last Updated: Nov. 30, 2023