Levels of Cost Share – What Blue Cross® Physician Choice PPO Members Need to Know

Levels of Cost Share – What Blue Cross® Physician Choice PPO Members Need to Know

Blue Cross Blue Shield of Michigan’s Physician Choice PPO plan stands out among other health care plans by giving members both flexibility and affordability. The plan leverages Organized Systems of Care—communities of caregivers including primary care doctors, specialists, and hospitals working together to provide coordinated care to our members – to offer unique access to our PPO network with lower cost share or out-of-pocket costs.

As a Physician Choice PPO member, you’ll need to select a primary care doctor in a Level 1 OSC to receive the lowest cost share. Out-of-pocket costs will vary based on where you choose to receive care (such as a hospital, urgent care clinic or specialist).

You still have the flexibility of seeing someone who is out-of-network, but the amount you pay will go up. You need to understand exactly how the levels of cost share work, and how that impacts what you have to pay. Here are the definitions of cost share for this plan.

Physician Choice PPO has three levels of cost share:

  • Level 1: Members who see a doctor in a Level 1 OSC pay the lowest out-of-pocket costs.
  • Level 2: Members will have higher out-of-pocket costs if they see a doctor in a different OSC than their primary care doctor, or doctors who are in the overall Blue Cross PPO network but not part of an OSC.
  • Level 3: Members are able to use out-of-network doctors that aren’t part of the Blue Cross PPO network, but it comes with the highest out-of-pocket costs.

Blue Cross® Physician Choice PPO combines choice of traditional PPO plans, with the added benefit of coordinated care. If you need help locating a doctor in one of our OSCs, visit our Find a Doctor tool at bcbsm.com.

To learn more about Blue Cross® Physician Choice PPO, visit PhysicianChoicePPO.com

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