This is an introduction to how an HMO, or health maintenance organization, works. We're going to go over how to select a primary care physician, how an HMO works, getting a referral to a specialist, and your drug formulary. If you have any further questions about these outside of this video you can contact Blue Care Network or you can go to our website, bcbsm.com.

So HMO coverage requires that you choose a physician that's within your network. If you choose to see a physician outside of the network, you may end up not having those services covered.

Before you select a provider, however, it's important to understand that those providers, even though they do participate within Blue Care Network, they may not participate with your particular policy. You can find out whether or not that doctor is within your network by accessing our website at bcbsm.com or by contacting the customer service number on the back of your card. Some regions of Michigan have focused provider networks that provide the same coverage as statewide networks within Blue Care Network, but at a lower cost, so it's always good to double-check with the resources we've provided on the website or with customer service.

Once you have selected your primary care physician, it’s very important to notify Blue Care Network. You can do that by calling us again at customer service; we're more than happy to change your primary care doctor for you at any time for any reason, or you can also change it with your member account online.

When you make your first appointment with your primary care physician, there are several things that you'll want to remember to talk about or bring with you. On our website, there is a downloadable checklist. There is also an online questionnaire called the health assessment. When you go to the appointment you'll want to make sure you have your ID card. You'll want to discuss any prescriptions that you might take. And you'll also want to discuss any specialty doctors that you might be seeing. That way, your primary care physician and the specialists can coordinate your care.

If you're changing primary care physicians or you're new to Blue Care Network, you'll definitely want to make sure that you get your medical records transferred. You just have to contact your former primary care physician and they'll get that sent over electronically to the new provider.

Your primary care physician should have access to the list of prescription drugs that are covered by your health plan. This list is called a drug list, or a formulary. You can also have access to this drug list by visiting our website at bcbsm.com or by contacting us and we'll help you locate it. If your drug requires plan approval, within the first 90 days of becoming a member, members can fill up to a 30-day supply of their medication, so you have time to talk to your doctor.

There's a few other things associated with the policy as well that are important to know as you go forward. For instance, your deductibles and co-pays. A deductible is essentially an amount that you have to pay prior to the plan paying for services. Once that deductible is met, you have cost-sharing that is basically your copays, your office visit copays. So when you go to your primary care physician you'll have a charge of 15 dollars or whatever your plan specifies. These things are important to remember so that you're not taken by surprise when you go to the office. Depending on your plans out-of-pocket expenses, these may not be your only costs. You can find your customer service telephone number on the back of your ID card and if you have any questions, feel free to give us a call. And welcome to Blue Care Network.