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:

PPO Network – A group of doctors and hospitals contracted by Blue Cross to create a network of participating providers, which is inclusive of more than 4,000 primary care doctors and 100 hospitals in Michigan

Organized Systems of Care (OSC)Communities of caregivers including primary care doctors, specialsts 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

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

Level 1 OSC – Doctors and hospitals considered in-network, offering the highest level of care at the lowest costs for the member

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 to pay the lowest costs. Level 2 or out-of-network health professionals will accrue different costs, with the highest costs coming from selecting care outside of your network

ReferralsWritten (or electronic) orders from primary care doctors that allows patients to see a specialist based on their specific health care need

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

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


Photo Credit: Sebastien Wiertz

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