Choosing a Primary Care Physician
You may select a family practitioner, internist or pediatrician from the Blue Shield HMO provider directory to be your Primary Care Physician (PCP). Each covered family member may choose a different PCP. Please contact Blue Shield Member Services when selecting your PCP to verify that the physician is still participating in the Blue Shield HMO Network.

Changing your Primary Care Physician
You and your covered dependents may select a new PCP within the same medical group at any time. Just call Member Services. If you call before the 15th of the month, the change will be effective the first of the following month.

Obtaining Medical Treatment
Except in life-threatening emergencies, call your PCP before seeking medical care. If you think you need to see a specialist, receive laboratory tests, be hospitalized or receive any other specialized care, see your PCP first. Your PCP will refer you to a specialist within the network when necessary. You must get approval from your PCP for all health care services in order to receive the highest level of benefits from your health plan.

In most instances, OB/GYNs cannot be selected as PCPs. However, women may self-refer to an OB/GYN for basic services without PCP approval. Basic services include an annual pelvic exam, pap smear, and breast exam. If you have questions about OB/GYN services, contact Member Services.

Laboratory Services
When you are referred by your PCP for an x-ray or lab test, request that the referral be made to a laboratory or hospital that participates in the Blue Shield HMO Network. If you cannot go to a participating hospital or laboratory, ask the facility to bill Blue Shield directly. The laboratory bill should include group name and number, the subscriber's name and social security number, patient's name, a copy of the assignment of benefits, and the PCP referral.

If the nonparticipating laboratory requires that you pay at the time services are rendered, request an itemized statement including the subscriber's name and social security number, patient's name, and the referring physician's name. Complete the appropriate claim form and attach it to the PCP referral form and mail the documents to Blue Shield. The address is printed on your Blue Shield HMO identification card. Blue Shield will reimburse you directly.

In Case of an Emergency
In the case of a life-threatening emergency, you should go to the nearest available medical facility to receive treatment even if you are out of town. Under your plan, you will receive in-network benefit level coverage for your out-of-area life threatening emergency treatment. However, in order to receive the highest level of benefits offered under your plan, you must get approval from your PCP within two working days or the next regular business day following emergency treatment.

Member Services
Phone 1-800-424-6521
Website http://www.mylifepath.com