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Health & Wellness

A total-health solution that surrounds everyone with the help they need to live healthier, feel better and save money doing it.

Choosing Doctors, Hospitals, and Other Health Care Professionals

In-network? Participating? Preferred? The different names that health plan companies use to categorize doctors, hospitals and other health care professionals can create a lot of confusion for your employees. We use the following terms to describe our relationships with health care professionals:  
“Network” or “In-network” denotes those health care professionals who have an agreement with us to provide care to our members.
“Out-of-network” indicates those health care professionals who do not have an agreement with us to provide care to our members.
“Preferred provider” denotes those health care professionals who have an agreement with us to provide care to members in our PPO products. Members from other BCBSGa/BCBSHP products may use these providers if they have out-of-network benefits because they still save money because of our negotiated arrangements with these providers.
“Participating” or PAR denotes those health care professionals who we have an agreement with us to provide health care to our members at discounted rates. All but one hospital in the state of Georgia is a member of our PAR network.
How can my employees find out if a particular doctor is in the network?
There are three ways to determine if a doctor, hospital or other health care professional is in the network:  
Look for the doctor’s name in our online directory. Members can access this directory from anywhere within bcbsga.com by clicking the “Find a Doctor” link - it’s quick, easy to use, and is updated weekly.
Look for the doctor’s name in the hard-copy Member Guide/Provider – if you do not already have a directory, you can request one from your Account Manager or customer care.
Call a customer care associate.
To find a national BlueCard® provider, members can visit the network directory at www.bcbs.com or call (800) 810-BLUE (2583).  
Do members in my group have to use an in-network health care professional in order to receive coverage?
That depends on what type of health care plan your group participates. For example, if you have an HMO, you are required to use health care professionals within our broad, statewide network so that we can offer you with wide access at a lower price. If you have a PPO, you have the freedom to visit any health care professional but you will pay more if you use out-of-network providers. For specific details regarding your group’s ability to receive coverage outside of the network, see your Certificate Booklet.  
What about emergency care that is received at an out-of-network hospital?
True emergency care is covered no matter where the services were received. A true emergency is the sudden onset of a medical condition with such severe symptoms that an average person with an average knowledge of health and medicine (also called a "prudent lay person") would seek medical care immediately because there may be:  
Serious risk to mental or physical health
Danger or significant impairment of body functions
Significant harm to organs in the body (heart, brain, kidneys, liver, lungs, etc.)
for a pregnant woman, danger to the health of the baby
If a member of your group ever needs true emergency medical care as described above, he or she should go immediately to the nearest medical facility.  
HMO and POS members who receive emergency treatment must notify their primary care physician within 48 hours after receiving care. Members are required to pay their emergency room copay at the time of service. This copay is waived if the member is admitted to the hospital.
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Blue Cross and Blue Shield of Georgia, Inc. and Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. are independent licensees of the Blue Cross and Blue Shield Association. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.