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Frequently Asked Questions

Physicians & Other Providers


Q: How do I find a network provider? Top of Page

A: Access the most up-to-date provider information with our online Provider Search. Here, you can locate providers by name, specialty, county or zip code The Provider Search information is updated weekly.

You can also contact Customer Service at 1-877-258-3334 for assistance locating a provider or to obtain a paper copy of a directory. Additionally, many employers stock directories in their Benefits Department.

Q: What is a primary care physician? Top of Page

A: BCBSNC believes in the value of maintaining a relationship with a primary care provider. These providers are general practice, family practice, internal medicine and pediatric doctors who deal with a broad range of health care issues. They also help members manage their health and make decisions about their health care needs.

In addition, participating primary care providers participate in cost-saving quality assurance and utilization management programs. They also coordinate patient care, allowing the patient to easily navigate the health care system. These activities serve to enhance the physician-patient relationship, as well as increase the practice of cost-effective, high-quality medicine.

Q: What types of providers are eligible to provide services? Top of Page

A:The following is a list of licensed medical and behavioral health professionals whose services are eligible for Plan benefits: 

  • Doctor of Medicine (MD)
  • Doctor of Osteopathy (DO)
  • Doctor of Dentistry (DDS) (DMD)
  • Doctor of Podiatry (DPM)
  • Doctor of Optometry (OD)
  • Doctor of Chiropractic (DC)
  • Doctor of Psychology (PhD)
  • Physical Therapists (PT)
  • Occupational Therapists (OT)
  • Respiratory Therapists
  • Nurse Midwives (CNM)
  • Audiologists (MA)
  • Physician's Assistants (PA)
  • Pastoral Counselors (PC)
  • Licensed Certified Social Worker (LCSW)
  • Certified Nurse Specialist (CNS)
  • Speech and Language Pathologists (SLP)
  • Family Nurse Practitioner (FNP)
  • Certified Substance Abuse Counselor (CSAC) with appropriate licensure
  • Licensed Marriage and Family Therapist
  • Licensed Professional Counselors (LPC)
  • Licensed Psychological Associate
  • Licensed Dietician Nutritionist (LDN)
  • Licensed Clinical Addiction Specialist (LCAS)
  • Psychiatric Registered Nurses
  • Pharmacists (Immunizations only)

The following is a list of some ineligible providers:

  • Individual who is not licensed and/or credentialed by the appropriate state/governing professional organization.
  • Doctor of Holistic/Naturopathic medicine
  • Doctor of Chinese/Oriental medicine
  • Acupuncturist
  • Massage therapist
  • Homeopath

The following providers would not be eligible to contract directly with BCBSNC.  These types of providers generally provide services under a Home Health Agency contract.

  • Home Care Aides
  • Certified Clinical Social Workers
  • Registered Nurse
  • Registered Nurse – Certified

Q: What are the advantages of using network providers? Top of Page

A: Network providers agree to:

  • Provide medical care at cost saving rates
  • File claims for you
  • Coordinate prior plan approvals, order records, verify benefits
  • Require no out-of-pocket payment for covered services provided to you, except where copayments or coinsurance may apply
  • Adhere to proven, cost-saving medical management practices such as certification for hospital admissions, concurrent review, case management and discharge planning
  • Accept BCBSNC's reimbursement as payment in full
  • Participate in BCBSNC's quality assurance program

Q: What happens if my current physician is not a network provider? Top of Page

A: If your current physician is not a BCBSNC network provider and you are just joining a BCBSNC health plan or changing health plans, we will assist you in finding a new provider. The continuity of care process will apply to Blue Care, Blue Choice and Blue Options plans if you are being seen regularly for an ongoing special condition or if you are in the second or third trimester of pregnancy or completing post-partum care.

If you are changing health plans, you can obtain information on how to request continuity of care from your employer or benefit administrator or by contacting BCBSNC Customer Service at 1-877-258-3334.

Continuity of care requests will be reviewed by a medical professional based on the information provided about specific medical conditions. Notification about eligibility for continuity of care will be sent after a decision is made. If a continuity of care request is approved, you may continue to see your current specialist for up to 90 days. BCBSNC will assist you in finding a network provider for any future services before the 90-day period expires.

Q: How do I change my primary care provider? Top of Page

A: To change your primary care provider, you can either call Customer Service at 1-877-258-3334 or visit My MemberServices at bcbsnc.com.

Q: Can I change my primary care provider any time I want? Top of Page

A: Yes. You may designate a new primary care provider at any time.

Q: What if a primary care physician cannot see me right away? Top of Page

A: Answers vary according to plan. For more information, please visit the FAQs on your plan's Member page.

Q: What if a network provider isn't available to treat my condition? Top of Page

A: Answers vary according to plan. For more information, please visit the FAQs on your plan's Member page.

Q: Can I go to a non-network provider? Top of Page

A: Answers vary according to plan. For more information, please visit the FAQs on your plan's Member page.