This article is intended for HMO members enrolled in an employer health insurance plan.
Your primary care physician (PCP) is your personal health care consultant. Your PCP works with you to coordinate all your health care needs.
If you need a specialist’s expertise, your PCP can refer you to one of the many specialists in the BlueLincs HMOSM network.
Medical Group Networks
When you choose your PCP, you are also choosing a specific medical group network. Many of BlueLincs HMO network PCPs are with a specific medical group or clinic that includes specialists, hospitals and other health care professionals.
If your PCP is with a medical group or clinic, your PCP will likely coordinate referrals through his or her group of specialists. And referrals may be reviewed by the group’s own Managed Care Committee.
Members do not need a referral to see a BlueLincs participating provider for a well-woman exam once every 12 months. This exam includes a pap smear, a pelvic exam and an occult blood lab.
Routine mammograms are also covered without a referral, subject to the limits shown in the Schedule of Benefits.
Any follow-up care required after a routine well-woman exam, including mammography screening, must be coordinated by your PCP. If additional specialty care is needed, your PCP will refer you to a provider in the BlueLincs HMO network.
Members do not need a referral to see a BlueLincs participating urologist for a well-man exam once every 12 months. This exam includes an office visit, a prostate exam and an occult blood lab.
Any follow-up care required after a routine well-man exam, including a PSA test, must be coordinated by your PCP.
For more information about your BlueLincs HMO plan, call the toll-free customer service number on the back of your member ID card or visit bcbsok.com.