Below, you'll find some great questions asked by members new to Blue Cross Blue Shield of Massachusetts. If you don't find the answer you are looking for, contact Member Service at the number on the front of your ID card.
First, contact Member Service at the toll-free number on the front of your ID card. A Member Service representative will explain your benefits, answer your questions, and work to resolve any problems you might be having. Most of the time, one call is all it takes to address your concerns.
If, after speaking with Member Service, you feel your issue is still not resolved, you may request a formal review through our Appeal Grievance Program. A grievance specialist will be assigned to your case, and will guide you through the process. Learn more about the Appeal and Grievance Program.
If you or a family member are having a life-threatening emergency, call 911 or your local emergency care service and get help immediately. Contact your PCP as soon as possible after you've been treated.
If you don't have a PCP and are concerned about coverage for your emergency care, just call the Member Service number on the front of your ID card—they're here to help.
If you need urgent or emergency care outside of our service area, go to the nearest health care facility. Call the Member Service number on the front of your ID card during the next business day.
If you need routine care (checkups, vaccinations, etc.) when traveling, check with Member Service before your appointment.
If your plan requires that you choose a PCP, you must get a PCP referral before seeing a specialist. Talking with a PCP can also help you understand what's involved with specialty care if you need it.
If your plan doesn't require that you choose a PCP, you can see a specialist or other health care provider without a referral. However, you'll still need to see a provider who participates with Blue Cross Blue Shield of Massachusetts in order to have your benefits covered at the highest level.
Your primary care provider (PCP) is the most important part of your health care team. With a comprehensive understanding of your medical history and conditions, your PCP will be your partner in everyday, preventive care, as well as the coordinator of any specialized care you may need. We believe collaborative relationships between you and our team of trusted, skilled doctors, provide you with the best possible care.
Your PCP will be your advocate, no matter what your health needs. He or she collaborates with our team of trusted specialists to be sure you’re getting the care you need. This allows your PCP to ensure good communication and coordination among all the providers involved in your care.
Before you seek specialty care, be sure to contact us so we can arrange any specialty care you may need. If you have a request for medical care services outside of our group, you should discuss this option with your PCP. He or she will work with you to make a decision, keeping accessibility, timeliness, cost, and quality of care in mind.
While not all of our plans require that you choose a primary care provider, having one is a great way to make the most of your Blue Cross Blue Shield of Massachusetts coverage.
Each covered member of your family may choose his or her own primary care provider (PCP), and choosing the right one is important. There are many different types of PCPs, including general practitioners, internists, pediatricians, family medicine physicians, and nurse practitioners. To choose the best fit for you or your family member, begin by asking for recommendations from the people you trust. You should also consider each PCP’s distance and accessibility from your work or home. Most importantly, talk with us to be sure that the practice can meet your personal health care needs.
For the most up-to-date provider listings, call the Find a Doctor Support Line at 1-800-821-1388 or visit www.bluecrossma.com/findadoctor.
Using the Find a Doctor tool, you can search for a PCP by:
- Language(s) spoken
- Hospital affiliation
- Medical group
- Extended/weekend hours
- Electronic capabilities (e.g., electronic medical records, electronic prescribing, and web consultation)
Once you select a PCP you have to inform Blue Cross Blue Cross Blue Shield of Massachusetts. You can select your PCP by logging in and visiting the My Account section and selecting Change My Primary Care Provider, or call Member Service at the number on the front of your ID card.
In general, you may change your PCP at any time. Simply create a Blue Cross Blue Shield of Massachusetts account or log in at MyBlue to select your PCP online, or call their Member Service line at the number on the front of your ID card