Can I use another doc in my PCP's practice if she is not there...I have BCBS HMO.?

Question

I have had a regualr BCBS HMO forever, but have ever had a problem seeing my doctor. i HAVE to go to the doctor today and she is not there. Can I see any doctor in the same group or will ins not cover it.

Answer 1

The doctors office has an agreement with BCBS HMO and would follow their rules.  I would guess that they would have your PCP sign off on your care and use your  PCP's tax ID when submitting the claim.  Talk to the doctors office and ask them how it will be billed, making them aware that you have an HMO.  

Also, you might want to look into changing your PCP if it seems to be a reoccurring factor with them not being available.

Answer 2

I used to work for a large health insurer that offered HMO plans.

At the company I worked for, it would not have been a problem for an individual to see another doctor in the PCPs office...if the PCP was not available that day and the individual was ill.

If you want to be certain that's the way your insurer works, why not give them a call?  They should be able to confirm that for you.

Answer 3

In my experience, the doctor's offices with multiple doctors have worked this out so it works. Call the doctor's office and find out for sure, but I'm sure they have it covered.

I have gone to the same big practice for years, and it is a rare thing to visit my primary care doc when I need to see a doctor quickly. However, I have been on multiple insurance companies, including HMO and PPO plans, and never had a problem with it.

I think this is something a big practice will know how to take care of.

Answer 4

You can usually see the on-call doctor in your current pcps office. Ask your doctor's office. They usually have a pretty good idea which doctor's can cover for one another, in their own practice.

Answer 5

Most HMO's will not allow you to see another doctor without a referral from your PCP except for emergencies.  If this is a real emergency (which I can't imagine it would be since you have had the time to post your question here and wait for an answer) it would most likely be covered.  If this is a true emergency, stop wasting time here and contact your HMO immediately to see where you can go.