Frequently Asked Questions
What happens if I don't choose a Personal Physician?
If you don't choose a Personal Physician when you enroll in the Blue Shield POS Plan, Blue Shield will choose one for you. Blue Shield will notify you of the selection and let you choose another Personal Physician if you're not satisfied. Remember, Personal Physician changes are effective the first of the month after Blue Shield is notified.
Do I need to choose the same Personal Physician as other members of my family?
In most instances, each covered family member may choose his or her own Personal Physician within Blue Shield's network. The exception is newborns and children placed for adoption. A newborn that is a mother's natural child must be in the same Medical Group/IPA as the mother. If the mother of the newborn is not enrolled as a member, or if the child has been placed with the subscriber for adoption, the Personal Physician selected must be in the same Medical Group/IPA as the subscriber.
Can I change Personal Physicians?
In general, you may change Personal Physicians at any time for any reason. Just call Blue Shield Member Services. In most cases, the change will be effective the first day of the month following notice of approval by Blue Shield.
What should I do if I want to see a specialist?
If you feel you need to see a specialist, you should discuss this with your Personal Physician. If you Personal Physician believes your medical condition or concerns are best treated by a specialist, they will submit a request to their Medical Group or IPA recommending that you be sent to a specialist. If the referral is approved, you will usually be sent to a specialist in your Personal Physican's Medical Group or IPA, and you will be charge your usual office visit co-payment. You always have the option to self-refer to a Preferred Provider within the Blue Shield network or a Non-Preferred Provider outside the network, but your financial responsibility will be more under these options (see Level of Care summaries).
Can I request a second opinion?
Yes. If there is a question about your diagnosis or you would like additional information regarding your condition in order to help determine the most appropriate course of treatment, you can ask your Personal Physician to refer you to another physician for a second opinion. If you request a second opinion about care received from your Personal Physician, the second opinion will be provided by a physician within the same Medical Group/IPA as your Personal Physician. If you request a second opinion about care received from a specialist, this second opinion can be provided by any Plan specialist of the same or equivalent specialty. All second opinion consultations must be authorized by the Plan. Your Personal Physician might also decide to offer a second opinion referral even if you do not request it. You always have the option to self-refer to a Preferred Provider within the Blue Shield network or a Non-Preferred Provider outside the network, but your financial responsibility will be more under these options (see Level of Care summaries).
Are preexisting conditions covered?
Yes, covered services for preexisting conditions are covered.
What should I do if I get a bill from an HMO provider?
Normally, you should not receive a bill when your Personal Physician provides or coordinates your care. You are responsible only for paying your co-payment at the time of your visit. Sometimes bills for covered services may be sent to you in error. If this should happen to you, call Blue Shield Member Services at 1-855-256-9404 as soon as possible. Blue Shield will need your subscriber number, a brief explanation of the circumstances surrounding the bill and information about whether or not your Personal Physician provided or approved the services. If you paid for or receive a bill for emergency care, call Member Services for assistance.