Skip to main content Skip to footer
 

Member Resources

Services you need when you need them

MyBSWHealth Member Portal

Your one-stop shop for most information and questions. With our 24/7 member portal, you can enjoy access to your health plan within a secure environment that includes resources you can count on from Baylor Scott & White Health Plan.

Medicare Advantage, Marketplace and Employer Group members

Other members


More Resources

Looking for care in your area? Baylor Scott & White Health Plan's online search tool helps you locate doctors, hospitals, pharmacies and more.

Access details on your plan's prescription drug network:

Remember to carry your Baylor Scott & White Health Plan member ID card with you at all times. You will need to show it to your provider(s) when you receive covered services. Your card contains important information, including your plan name, member ID number, copay/coinsurance amounts and customer service phone numbers to call if you have questions.

You can also contact our Customer Service team and request your new card be mailed to you.

NOTE: Information shown on your ID card may vary based on your plan benefits.

Need care advice? Should you see a doctor? Get the info you need today! Members can talk to a nurse for answers 24/7.

Need to view documentation about your plan?

Health insurance can be confusing, so we've compiled some resources to help you understand your plan and ask the right questions about your coverage.

Healthcare On the Go

Members have access to board-certified doctors, pediatricians, licensed therapists and more using your smartphone, tablet or desktop computer.

MyBSWHealth Virtual Care

my bsw health mobile app

Receive care from the comfort of your home, or anywhere in Texas, 24/7. Simply log into MyBSWHealth.com or download the app.

Conduct an eVisit for common medical conditions and get care fast

  • Complete a short, online interview about your symptoms.
  • Receive a response from a Baylor Scott & White Health provider within one hour.
  • Select your preferred pharmacy to send prescriptions (if needed).

Schedule a same-day Video Visit with a provider, face to face

  • Schedule your appointment.
  • Talk with a Baylor Scott & White Health provider live about your symptoms.
  • Visits length varies, based on your needs. Often as quick as 10 - 15 minutes.
  • Provider will send prescription (if needed) to your preferred pharmacy.

Virtual Care Powered by MDLIVE

md live mobile app

Virtual care options, powered by MDLIVE, are available 24/7 (including holidays) for most Employer Group and all Marketplace members. Check your member guide for information on your group's benefits.

  • Access to board-certified doctors, pediatricians, licensed therapists and more
  • Secure and easy visits by phone or video
  • Prescriptions sent to your pharmacy when needed

Registration

Registration is easy and takes only a few minutes.

  • To register, visit MDLIVE or call 800.718.5082.
  • When you register, be sure to tell them you're a Baylor Scott & White Health Plan member and have your member ID card available.

NOTE: If you already have an account with MDLIVE through a different insurance plan, you will need to re-register as a Baylor Scott & White Health Plan member. Be sure to save your new username and password so you can log in to the correct account.

Access

Once you have registered with your Baylor Scott & White Health Plan account, you can access MDLIVE:

Health and Wellness Programs

Treating yourself right isn't a trend. It's a good habit. And it's a habit anyone can pick up. Take advantage these programs to help you improve the areas of your life that need a boost.

Better tools
make it easier

We all have different healthcare needs. Handle them your way with the MyBSWHealth app. Download the app today and take a hands-on approach to your healthcare.

Text BETTER to 88408
QR code - scan to download the my bsw health app
My health. My Way.
Schedule Appointments
Video visit with your doctor
Message your doctor
Get test results
Manage your family's health

Community Resources

Access valuable healthcare programs and event information, including support groups, educational sessions, volunteer opportunities and more available throughout the communities we serve.

  • FreeDentalCare: Online list of free or reduced-price dental care providers

Mandatory Disclosures

For BSWHP HMO/EPO/PPO members, where applicable.

Provider Network Access Plan for members

Your BSWHP plan includes access to a network of providers (i.e., doctors, hospitals, other healthcare providers, etc.) to meet your healthcare needs. These providers are contracted with us and are considered "in-network." They are available to you for a full range of covered healthcare services. This plan provides insight to the process we use to develop and maintain adequate provider access.

EPO outline of coverage

Notice of special toll-free complaint number

To make a complaint about a private Psychiatric Hospital, Chemical Dependency treatment Center, or Psychiatric or Chemical Dependency Services at a General Hospital, call: 800.832.9623 Your complaint will be referred to the state agency that regulates the hospital or chemical dependency treatment center.

Any contracted BSWHP provider can provide telemedicine medical services and/or telehealth services, for certain circumstances and conditions, to a BSWHP member.

  • No pre-authorization is required by an in-network BSWHP provider. However, if an out-of-network provider is needed, pre-authorization is required. In these cases, BSWHP requires a 48-hour advance notice prior to the member receiving telemedicine services from an out-of-network provider.
  • Covered services are subject to all applicable copayments, coinsurance and deductible amounts, not exceeding those for the same covered service provided in an in-person location such as a doctor's office, clinic or hospital.

If you have any questions, contact the Plan Customer Service at the number on the back of your BSWHP member ID card.

BSWHP is a State of Texas not-for-profit company, organized for the purpose of operating an Independent Practice Association (IPA)-model health maintenance organization. BSWHP provides prepaid medical, hospital and related comprehensive healthcare services to HMO subscribers and their enrolled dependents within our approved service area.

BSWHP does not employ incentives to encourage barriers to care and services, specifically reward practitioners or other individuals conducting utilization review for issuing denials of coverage or service care, or provide incentives for utilization review decision makers that result in underutilization. Utilization management decision-making is based only on the appropriateness of care and service and the existence of coverage.

Health Maintenance Organization (HMO) products are offered through Scott and White Health Plan dba Baylor Scott & White Health Plan, and Scott & White Care Plans dba Baylor Scott & White Care Plan. Insured PPO and EPO products are offered through Baylor Scott & White Insurance Company. Scott and White Health Plan dba Baylor Scott & White Health Plan serves as a third-party administrator for self-funded employer-sponsored plans. Baylor Scott & White Care Plan and Baylor Scott & White Insurance Company are wholly owned subsidiaries of Scott and White Health Plan. These companies are referred to collectively in this document as Baylor Scott & White Health Plan.

When you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing.

What is "balance billing" (sometimes called "surprise billing")?

When you see a doctor or other healthcare provider, you may owe certain out-of-pocket costs, such as a copayment, coinsurance and/or a deductible. You may have other costs or have to pay the entire bill if you see a provider or visit a healthcare facility that isn't in your health plan's network.

"Out-of-network" describes providers and facilities that haven't signed a contract with your health plan. Out-of-network providers may be permitted to bill you for the difference between what your plan agreed to pay and the full amount charged for a service. This is called "balance billing." This amount is likely more than in-network costs for the same service and might not count toward your annual out-of-pocket limit.

"Surprise billing" is an unexpected balance bill. This can happen when you can't control who is involved in your care—like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider.

You are protected from balance billing for:

Emergency services

If you have an emergency medical condition and get emergency services from an out-of-network provider or facility, the most the provider or facility may bill you is your plan's in-network cost-sharing amount (such as copayments and coinsurance). You can't be balance billed for these emergency services. This includes services you may get after you're in stable condition unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services.

Certain services at an in-network hospital or ambulatory surgical center

When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers may bill you is your plan's in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist or intensivist services. These providers can't balance bill you and may not ask you to give up your protections not to be balance billed.

If you get other services at these in-network facilities, out-of-network providers can't balance bill you, unless you give written consent and give up your protections.

You're never required to give up your protections from balance billing. You also aren't required to get care out-of-network. You can choose a provider or facility in your plan's network.

When balance billing isn't allowed, you also have the following protections:
  • You are only responsible for paying your share of the cost (like the copayments, coinsurance, and deductibles that you would pay if the provider or facility was in-network). Your health plan will pay out-of-network providers and facilities directly.
  • Your health plan generally must:
    • Cover emergency services without requiring you to get approval for services in advance (prior authorization).
    • Cover emergency services by out-of-network providers.
    • Base what you owe the provider or facility (cost-sharing) on what it would pay an in-network provider or facility and show that amount in your explanation of benefits.
    • Count any amount you pay for emergency services or out-of-network services toward your deductible and out-of-pocket limit.

If you believe you've been wrongly billed, you may contact the No Surprises Helpdesk at 800.985.3059.

Visit www.cms.gov./nosurprises for more information about your rights under federal law.

NCQA Health Plan seal

NCQA Accreditation

Baylor Scott & White Health Plan has received Accreditation from the National Committee for Quality Assurance (NCQA). This means that Baylor Scott & White Health Plan's service and clinical quality meet the basic requirements of NCQA's rigorous standards for consumer protection and quality improvement. Consumers can easily access organizations' NCQA statuses and other information on healthcare quality by visiting ncqa.org or calling NCQA Customer Support at 888.275.7585.

Accredited NCQA Health Plan seal
 

Prior Authorization

Prior authorization is sometimes called pre-certification or pre-notification. Prior authorization verifies whether medical treatment that is not an emergency is medically necessary. It also determines if the treatment matches the diagnosis and that the requested services will be provided in an appropriate setting. During prior authorization, Baylor will also verify if the Member has benefits.

Prior authorization DOES NOT guarantee payment. Even if a Provider obtained the required prior authorization, Baylor must still process a Provider’s claim to determine if payment will be made. The claim is processed according to:

  • Eligibility
  • Contract limitations
  • Benefit coverage guidelines
  • Applicable State or Federal requirements
  • National Correct Coding Initiative (NCCI) edits
  • National Correct Coding Initiative (NCCI) edits
  • Texas Medicaid Provider Procedures Manual (TMPPM)
  • Other program requirements, as applicable

Providers must submit the Prior Authorization Request Form, which you can view and download here. The form must include the following information to initiate the prior authorization review process:

  • Member name
  • Member date of birth
  • Member number
  • Requesting provider name
  • Requesting provider’s National Provider Identifier (NPI)
  • Rendering provider’s name
  • Service requested:
    • Current Procedural Terminology (CPT)
    • Healthcare Common Procedure Coding System (HCPCS)
    • Current Dental Terminology (CDT)
  • Service requested start and end date(s)
  • Quantity of service units requested based on the CPT, HCPCS, or CDT requested
  • Requesting Provider’s Dated Signature

Please note any prior authorization requests missing essential information will not be processed and a new request will need to be submitted. To avoid delays in authorization or administrative denials, Providers are encouraged to submit sufficient documentation to validate the medical necessity for the services being requested. This may include, current progress notes, history and physical, radiology or laboratory results, consult notes/reports, treatment plans showing progress to goals (e.g. therapy requests) or similar medical record documentation to illustrate medical necessity.

When BSWH receives a request for prior authorization and the request does not contain complete clinical documentation and/or information:

  • BSWH will notify the Member by letter that an authorization request was received but cannot be acted upon until BSWH receives the missing documentation/information from the requesting Provider. The letter will include the following information:
    • A statement that BSHW has reviewed the PA request and is unable to make a decision about the requested services without the submission of additional information.
    • A clear and specific list and description of missing/incomplete/incorrect information or documentation that must be submitted in order to consider the request complete.
    • Timeline for the provider to submit the missing information.
    • Contact information and modes of communication for provider inquiry if necessary.
  • BSWH will contact Provider via fax or phone and request documentation for completion of the medical necessity review within three business days of BSWH receipt of request (where applicable).
  • If BSWH does not receive the documentation/information by the end of the third business day of our request to the requesting Provider, the request will be submitted to the Medical Director no later than the seventh business day after receipt of request (where applicable).
  • BSWH will render a decision no later than the tenth business day after the request received date.

Supporting Clinical Documentation

Scroll To Top