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Blue Choice Frequently Asked Questions

How do members change their primary care physician?


Members can log in to Member Secured Services or contact customer service to select a new primary care physician.


What if a member is temporarily residing outside of their PCP's area or a dependent is living away from home?


When in-state, the member or dependent should use our Physician Search to locate a Blue Choice POS provider. Members can also contact customer service for assistance with locating a provider or to request a provider directory. Once the member has found a provider near their temporary area of residence, they should contact customer service to change their PCP.

What if a member is living out of state?


More than 85 percent of all doctors and hospitals throughout the U.S. contract with Blue Cross and Blue Shield plans. If a member is living out of state or if they are temporarily out of network, they should call the number on the back of their ID card (800-810-BLUE) to locate participating providers.

How does a member schedule their first appointment?


To make a first appointment with their PCP, members should call the physician to see if medical records need to be transferred. The physician can provide the forms or information necessary to request the information from the former physician. With some group practice arrangements, members may be given an appointment to see one of the PCPs in the group, or they may request to see their specific PCP.

How does a member cancel an appointment?


To cancel an appointment, members should call their PCP's office at least 24 hours in advance. This enables the PCP to schedule someone else for that time.

Do members receive identification cards?


Within six weeks of a group's open enrollment, we'll send ID cards to new members. We'll send one card for a single-member contract and two cards for a two-person or family contract. Members should keep their ID cards with them at all times and show the card each time they receive care.


What if a member needs to be hospitalized?

To be covered at the in-network level, a Blue Choice physician must arrange all hospital admissions or services. If the member's PCP or another Blue Choice physician does not arrange their hospitalization, the member will have to pay a copayment, after they meet their annual out-of-network deductible.


Without authorization, care is paid on an out-of-network basis, even if members go to a network hospital.

What if a member needs to go to the emergency room?


A medical emergency is a condition that occurs suddenly and unexpectedly, and that could result in serious bodily harm or threaten life unless treated immediately.


Examples of emergencies include:

  • Heart attack
  • Stroke
  • Inability to breathe

An accidental injury is caused by an action, object, or substance outside the body.


Examples of accidental injuries include:

  • Medicine overdose
  • Swallowing poison
  • Allergic reactions
  • Inhaling smoke, carbon monoxide or fumes

Emergency room service for medical emergencies and accidental injuries are covered when preauthorized by the member's PCP or another Blue Choice provider, or when the lack of immediate medical attention could result in permanent damage to the member's health. If an emergency room service does not meet either of these standards, limited or no payment for the services may be made.


Here's what members should do if they have a medical emergency or accidental injury:

  • Always follow the advice of the PCP.
  • If a member has an immediate and unforeseen medical emergency and the time it takes to contact their PCP may mean permanent damage to the member's health, they should go directly to the nearest emergency room or call 911 for assistance.
  • It is suggested, but not required, that the member, hospital, or someone acting on behalf of the member, notify the doctor within 48 hours or as soon as it is medically reasonable to do so.
  • Members should also contact their PCP for any follow-up care.

What if a member needs mental health services?


If the member's behavioral health benefits are covered through Blue Choice, Magellan Health Services, the statewide Blue Choice behavioral health manager, will refer them to a specialist in mental health or substance abuse services.


Members can call Magellan Health Services at 800-394-4983 for a referral at any time, or ask their PCP for help contacting Magellan. It is not necessary for the member to contact their PCP before calling Magellan. The Magellan mental health or substance abuse provider will set up the member's treatment plan and arrange the required authorizations on their behalf.

Do members need to submit claims?


When members receive services from a network provider, they won't need to submit claim forms. If they seek out-of-network services from a non-Blue Choice provider, they may have to submit a claim form or send an itemized receipt to be reimbursed for covered expenses.


Whether members receive in- or out-of-network care, they'll receive an Explanation of Benefits statement that describes how much we paid and how much they may be responsible to pay.