Getting the “max value” from your health plan
- April 14, 2025
Knowing your health insurance is there to help cover the costs of treating illnesses or injuries provides peace of mind. We also provide ways to keep you as healthy as possible. By taking advantage of your health plan’s benefits and services, you can improve your health and keep your medical costs low.
The ins and outs of staying in-network
Your first step to reducing costs is to choose an in-network provider or facility to get your member discount. A network is a group of doctors, hospitals, surgery centers or other providers who have agreed to provide medical services to members of a healthcare plan for a negotiated price. Following your visit, you will see this reduced amount listed in your explanation of benefits (EOB). As a health plan member, your out-of-pocket costs may include a copay, coinsurance or a deductible.
Healthcare providers who are out of network have not negotiated special rates with your health plan and will almost always charge you higher prices. In an emergency, go to the closest emergency department and do not worry about remaining in network.
How do I find in-network doctors and facilities?
You can find in-network healthcare providers at arkansasbluecross.com/findcare or by logging into Blueprint Portal. You also can call the number on the back of your member ID card to visit with our customer service representatives, who can help you find an in-network healthcare provider near you.
The importance of wellness visits
While some people may be tempted to skip their annual wellness exams because they believe they are healthy, doing so can be risky. Blood tests can reveal a health issue in its early stages, long before any symptoms appear. The questions your doctor asks during your visit may even reveal a health problem.
Having a regular family doctor helps you get the best possible care. Wellness visits allow you to keep track of necessary screenings and get to know your doctor so you will feel comfortable with them if you do get sick.
What’s covered at no additional cost?
Preventive services provided at no additional cost include:
- An annual wellness visit with your primary care provider.
- An annual flu shot: most health plans cover a flu shot 100%.
- Women’s health visit (Pap smear beginning at age 25, etc.).
- Annual mammograms (usually beginning at age 45) and routine x-rays to check for any signs of cancer or other abnormalities.
- Childhood vaccinations (immunizations for measles, mumps, rubella, polio and more are covered at 100%).
- Colonoscopy (routine screening for colon cancer) once every 10 years, usually at age 45.
- Those with dental insurance also have six-month dental cleanings and check-ups.
Frequency of covered preventive screenings
- Apart from your annual wellness visits, your other preventive screenings are covered at different frequencies based on your age and health risks. These include colonoscopies, mammograms, and PAP smears. You can find screening guidelines from the American Cancer Society.
The difference between preventive and diagnostic visits
- Preventive screenings look for diseases or conditions before symptoms or signs occur.
- Diagnostic tests are done when your doctor needs to know the cause of your symptoms or health issues.
During your wellness visit, if you discuss a specific problem you’ve been having and your provider runs additional tests or treats you for that issue, your wellness visit may become a diagnostic visit, and you may be billed for the extra costs.
Getting the best results from your doctor’s visit
- Write down any concerns or questions about your health, including your mental health.
- Write down any changes in your health, including when the change began.
- Bring a list of current prescriptions and over-the-counter medications, including vitamins and supplements. Include the dosages, how often you take them and who prescribed them.
Asking for a referral if needed
Some plans don’t require a referral, but some specialists do. If so, your primary care physician can do this for you. To save money, make sure the specialist is also in your health plan’s network.
Resolving coverage issues
If you have a service that should be covered but isn’t, contact our customer service representatives or call the number on the back of your member ID card. We also provide a complete list of service numbers if you have additional questions.
Not all members have the same services and benefits so it’s important to become familiar with what your plan or employer offers. Visit Blueprint Portal to register or sign in. From there, you can visit the Policy section to find Coverage & Copays and a Quick Start Guide where members of all health plans can find a Schedule of Benefits.