When you see your provider, they're in-network because they have a contract with Blue Cross and Blue Shield of Texas or UnitedHealthcare. It means your provider and the insurer agreed to a set price for each treatment or procedure in advance. The plan agrees to pay for the medical costs covered. Depending on the treatment or procedure, you might pay copays or coinsurance.
Contracted providers can be a doctor, hospital or other medical professionals and health care facilities. Contracts can be for a year or multiple years.
Why do we need contracts?
Contracts give you access to high-quality providers, keep your costs down and make it convenient for you to find a provider you can trust. If a contract didn't exist between the provider and your health plan, you might have to pay more or the full amount for your care.
For the provider, it makes it easier for them to get paid after treating you. Your provider gathers information from you to submit the claim to the health plan. Then the health plan processes the claim and pays the provider.
What does a contract negotiation mean for you?
Because contracts have term limits, the insurer needs to renew or update them when the contract ends. Please don't be surprised when you see announcements about negotiations. The insurers negotiate contracts to keep health care costs down for you.
The insurers work with providers to find solutions in your best interest. They advocate on your behalf for high-quality, cost-effective health care. It's a responsibility they take seriously.
How can I find out about negotiations?
TRS health plans notify participants about significant negotiations that could impact them. Usually, they resolve favorably and without cause for concern. But if the provider does go out of network, you still have access to other in-network providers, hospitals and facilities. Your TRS health plan can help you find new care options or help continue your care.
Resources for TRS-ActiveCare and TRS-Care Standard
Provider Finder®
If you need help finding a provider, use Provider Finder® to search by location, gender and specialty. A PHG can help you find an in-network provider 24/7. Call 1-866-355-5999 or chat through the BCBSTX App.
Resources for TRS-Care Medicare
Find In-Network Care