Find a doctor disclaimer

Our healthcare provider* networks are designed based on the same criteria, no matter whether you purchased your plan through an employer, through BCBSRI directly, or through HealthSource RI. All plans include:

• Primary Care Providers such as doctors listed as specializing in internal medicine and pediatrics.
• Specialists such as cardiologists, surgeons, neurologists, orthopedics, obstetricians, chiropractors, and other medical practitioner types.
• Behavioral healthcare providers such as psychiatrists, psychologists, mental health counselors, and other types of behavioral health providers.
• Organizational providers such as hospitals, home health agencies, skilled nursing facilities, and free-standing surgical centers.

All healthcare providers must meet our credentialing requirements, meaning that they have appropriate training and certification in their fields of medicine, and we contract with physicians and healthcare providers throughout the State of Rhode Island and neighboring counties in Massachusetts and Connecticut. To obtain additional information on a provider, please call customer service at the number on the back of your ID card. We do not use quality, member experience, or cost-related measures to select providers for participation. However, we may make use of these measures to communicate quality and cost efficiency ratings to our members for informational purposes. For some of our plans, member cost sharing will be lower for providers who are distinguished from their peers on cost and quality measures. Additionally, to assess member satisfaction with our services, we make use of member feedback and surveys as part of the evaluation process. We use this data to identify opportunities for improvement, such as ensuring adequate and timely provider accessibility (for example, access within a reasonable driving distance).

Our hospital network is designed based on the same criteria, no matter whether you purchased your plan through an employer, through BCBSRI directly, or through HealthSource RI. All hospitals must meet our credentialing requirements and be Joint Commission (JC) or Det Norske Veritas (DNV) accredited. We contract with hospitals throughout the State of Rhode Island and neighboring counties in Massachusetts. We do not use quality, member experience, patient safety, or cost-related measures to select hospitals for participation. However, we may make use of these measures to communicate quality and cost efficiency ratings to our members for informational purposes. For some of our plans, member cost sharing will be lower for hospitals that are distinguished from their peers on cost and quality measures. Additionally, to assess member satisfaction with our services, we make use of member feedback and surveys as part of the evaluation process. We use this data to identify opportunities for improvement.

Geographic Standards

Every BCBSRI network is designed so that is contains a sufficient variety of primary care providers, facilities, and specialists within a specific geographical area. We select providers and facilities with the aim of ensuring “network adequacy” – that is, to make sure that for all of our covered services, you’ll find a provider In-Network who can offer it to you. It is important to note, however, that quality, member experience, and/or cost-related measures are not used in our selection of providers or facilities. Below are our geographic access standards:

About Our Provider Directory Information

The information provided in this directory is not an endorsement of a particular healthcare provider or hospital. This tool only serves as a general educational aid concerning provider name and location information, and is not a referral or recommendation of any particular healthcare provider or hospital.

The information in this directory comes from a variety of sources, including self-reported information from practitioners and facility providers. The accuracy of this information on the website depends upon whether the self-reported information is correct and whether we receive it in a timely manner. Where provider group information is provided, it is important to confirm the individual provider’s participation in the specific plan’s network, as not all providers in a Group may be participating. The composition of our provider network is subject to change without notice.

Blue Cross and Blue Shield Licensees have made reasonable efforts to validate that the information displayed is up to date and accurate. Please call the provider prior to scheduling an appointment to verify that the provider continues to be part of the network. Neither the Blue Cross and Blue Shield Association nor any of its Licensees shall be liable for any losses, damages, or uncovered charges as a result of using this provider locator website or receiving care from a provider listed in this website.

This describes how we verify and update information about the doctors and other health care providers in our Provider Directory.

*Provider is defined as a licensed or certified professional who provides medical care or behavioral healthcare services.