New Member Frequently Asked Questions

Important issues for people just getting started with Blue Cross Blue Shield of Massachusetts.

Q. What's the role of my primary care physician?

A. By coordinating your care through a primary care physician, you can develop a relationship with a trusted health care provider who will become familiar with your unique health care concerns. If you need a specialist, your primary care physician can refer you to one—and give your specialist background about your condition and any previous treatment you may have had.

While not all of our plans require that you choose a primary care physician, having one is a great way to help you make the most of your Blue Cross Blue Shield of Massachusetts coverage.

Back to Top

Q. How do I choose a primary care physician?

A. If you need help finding a primary care physician, you can call our Physician Selection Service at 1-800-821-1388, or use our Find a Doctor feature to browse an online list of physicians.

Once you choose a primary care physician, make an appointment for an initial visit, which will help you and your doctor to get to know each other. Be sure to tell your doctor all of your relevant medical history—it's important to ensure that you get the best care for your individual needs.

Back to Top

Q. What if I need to see a specialist?

A. In general, calling your primary care physician before seeking treatment from a specialist ensures that you get the effective, coordinated care that's right for you and your specific health concerns. Talking with a primary care physician can also help you understand what's involved with specialty care if you need it.

If your plan doesn't require that you choose a primary care physician, you can see a specialist or other health care provider without a referral. However, you'll still need to see a provider who participates with Blue Cross Blue Shield of Massachusetts in order to have your benefits covered at the highest level.

Different plans offer varying services, so be sure to read your Summary of Benefits or speak with your plan administrator if you have questions. You can also call Member Service at the number shown on the front your ID card.

Back to Top

Q. What if I need to see a doctor right away?

A. At Blue Cross Blue Shield of Massachusetts, nothing is more important to us than our members' good health. Urgent care and emergency care may sound alike, but here's the distinction:

Urgent care is for a condition that may need prompt attention, but is not life-threatening. An urgent care concern can be anything from an earache to a sprained ankle. The Blue Care® Line is one great way to determine whether you can treat an urgent care concern at home, or whether you should contact your primary care physician. All Blue Cross Blue Shield of Massachusetts members have access to the Blue Care Line, which is staffed by trained nurses who can help you determine the best way to treat your condition.

If you have an urgent health care need, call your primary care physician first. Your doctor will either treat you or advise you on what to do. All of our plan providers have 24-hour telephone coverage.

The Blue Care Line can be reached toll free at 1-888-247-BLUE (2583).

Back to Top

Q. What if I have a life-threatening emergency?

A. Emergency care is for a condition that needs immediate treatment, or for a situation that, if left untreated, might cause permanent injury. Emergency care situations include heart attack, stroke, poisoning, or deep, severe wounds that won't stop bleeding. At Blue Cross Blue Shield of Massachusetts, nothing is more important to us than your good health. If you (or a family member) are having a life-threatening emergency, call 911 or your local emergency care service, and get help immediately. Contact your primary care physician as soon as possible after you've been treated.

If you don't have a primary care physician and are concerned about coverage for your emergency care, just call the Member Service number shown on the front of your ID card—they're here to help.

Back to Top

Q. What if I'm on vacation and I need medical care?

A. If you need urgent or emergency care outside of our service area, go to the nearest health care facility. Call the Member Service number shown on the front of your ID card during the next possible business day.

If you need routine care (checkups, vaccinations, etc.) when traveling, check with Member Service before your appointment.

Back to Top

Q. What if I have a problem or concern regarding my coverage?

A. First, contact Member Service at the toll-free number shown on the front of your ID card. A Member Service representative will explain your benefits, answer your questions, and work to resolve any problems you might be having. Most of the time, one quick call is all it takes to address your concerns.

If, after speaking with Member Service, you feel your issue is still not resolved, you may request a formal review through our Grievance Program. A grievance specialist will be assigned to your case, and will guide you through the process. For more information on this program, check out your Member Rights.

Back to Top

Q. What is Member Self Service?

A. Member Self Service gives you the convenience of managing your coverage, your way—safely and securely.

It's quick, easy, and secure. (You'll need to refer to your Blue Cross Blue Shield of Massachusetts ID card when you register, so keep it handy.)

After you register, you'll have immediate access to*:

  • Review Your Benefits
  • Review Your Deductible/Co-Insurance
  • Change Your Primary Care Physician
  • Select Quality Care hospital comparison tool
  • MyBlueHealth, where you can take a health assessment, or use online tools for nutrition, fitness, stress management, smoking cessation and more.

To access additional, secure features—including claim summaries, pharmacy benefits, or your Blue Care Account, if you have one—you'll need to use your confidential personal identification number (PIN). You'll receive your PIN by mail within three to five business days after you register.

* Because individual benefits vary, some services may not be available to all members. Check with your plan administrator, or review your Summary of Benefits, for more details.

Back to Top

Q. How do I register for Member Self Service?

A. Register now for Member Self Service. It's quick, easy, and secure. (You'll need to refer to your Blue Cross Blue Shield of Massachusetts ID card when you register, so keep it handy.)

After you register, you'll have immediate access to*:

  • Review Your Benefits
  • Review Your Deductible/Co-Insurance
  • Change Your Primary Care Physician
  • Select Quality Care hospital comparison tool
  • MyBlueHealth, where you can take a health assessment, or use online tools for nutrition, fitness, stress management, smoking cessation and more.

To access additional, secure features—including claim summaries, pharmacy benefits, or your Blue Care Account, if you have one—you'll need to use your confidential personal identification number (PIN). You'll receive your PIN by mail within three to five business days after you register.

* Because individual benefits vary, some services may not be available to all members. Check with your plan administrator, or review your Summary of Benefits, for more details.

Back to Top