What Does It All Mean? Breaking Down the Blue Cross® Physician Choice PPO Lingo

What Does It All Mean? Breaking Down the Blue Cross® Physician Choice PPO Lingo

No matter what plan you have, understanding all of the lingo can help you to effectively use your plan in the most cost friendly way. This remains true with the innovative Blue Cross® Physician Choice PPO plan. Members of this plan will need to fully understand what being part of an Organized Systems of Care means, as well as how referrals work, for example.

We’ve broken down key phrases associated with the Blue Cross® Physician Choice PPO plan to ensure you are armed with all the information you need to understand the ins and outs of this new offering:

Comprehensive Coverage – The same wide range of services, including all essential health benefits and medical coverage you would expect from a Blue Cross PPO plan

Cost Shares – Each level of OSC that applies to each member of your family, meaning every member of the family must select a doctor in a Level 1 OSC before receiving services to be eligible for the lowest costs. Members will still have the choice to keep their current doctor, select no doctor at all, or choose a doctor who is not in a Level 1 OSC (but they’ll have higher costs).

Level 1 OSC – Doctors and hospitals that provide the highest level of care at the lowest costs for the member

PPO Network – Doctors and hospitals in the Blue Cross PPO network that aren’t part of a Level 1 OSC

Organized Systems of Care (OSC)Communities of caregivers including primary care doctors, specialists and hospitals working together to provide coordinated care to members

Out-of-Pocket Costs – The dollar amount you’ll pay in deductibles, copayments and coinsurance during one plan year

Primary Care DoctorsThe doctor you’ll see most often for everything from routine wellness visits and screenings to non-emergency illnesses, as well as for referrals to specialists

ReferralsElectronic orders from Level 1 primary care doctors that allow patients to receive services from doctors and hospitals outside of their primary care doctor’s Level 1 OSC based on their specific health care needs in order to pay Level 1 cost share

Blue Cross® Physician Choice PPO Market Region – Counties in Michigan where the majority of OSCs are located, with the most doctors and hospitals

PC PPO Market Region (Updated 11.28.18)

Physician Choice PPO Market Map

 

 

 

 

 

 

 

 

 

 

 

 

For more information about Blue Cross® Physician Choice PPO, please visit physicianchoiceppo.com.

 

Photo Credit: Sebastien Wiertz

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