Optimizing Your Plan: Referrals with Blue Cross® Personal Choice PPO

Blue Cross® Personal Choice PPO offers access to coordinated health care by way of Blue Cross’ Organized Systems of Care (OSC), communities of doctors and hospitals in our expansive PPO network. The result is personalized, coordinated care that gives you lower out-of-pocket costs.

OSCs include primary care doctors, specialists and acute care hospitals. If you’ve selected a primary care doctor in an OSC that is designated as Level 1 and you want to use services from a specialist or hospital within that Level 1 OSC you do not need a referral. If you need services from a specialist or hospital outside of your OSC, you’ll need a referral to visit that specialist or hospital—or pay higher out of pocket costs

What is a referral?

Referrals are written (or electronic) orders from your primary care doctor that allows patients to see a specialist based on their specific health care needs.

How do referrals work with Personal Choice PPO?

  • Ask your primary care doctor to submit a referral before you receive a service from a doctor or hospital that is outside your OSC, but still within the Blue Cross PPO network.
  • After your doctor submits the referral, you’ll receive a letter from Blue Cross once the referral is approved.
  • The letter will have the name of the doctor that submitted your referral, the name of the doctor or hospital you’ll be going to for care and the time frame to schedule your visit.
  • You’ll also be able to see all your referral information, if your referral has been approved, and print letters by logging into your account at bcbsm.com.
  • Your referral is valid as long as the doctor or hospital you use is where you were referred, your service was received within the Blue Cross PPO network, and your visit was within the time frame noted on your referral.

For more information on Blue Cross® Personal Choice PPO visit, PersonalChoicePPO.com.

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