One of the hallmarks of having your Blue Cross Blue Shield of Michigan card is being able to access care wherever and whenever you need it – anywhere across the country. Our members benefit from our nearly 80-year heritage of promoting broad access to care and we’re proud to offer it.
Our members also expect us to promote affordable care – and affordable insurance. Sometimes, “access” and “affordability” are qualities that compete against each other. It’s our obligation to our members to do our best to promote both.
For instance, in Michigan, Blue Cross negotiates payment terms with doctors and hospitals on behalf of our members that offer significant discounts on covered services. These “in-network” providers of care help keep the cost of care and insurance more manageable. This is why, when you go to an “in-network” provider, your cost sharing is typically lower.
Services offered outside of Michigan sometimes don’t receive those same deep discounts from providers of care. So, an “in-network” service outside Michigan may cost a lot more than the same service offered by a quality doctor or hospital in Michigan.
In an effort to help maintain health care costs while still providing reliable access to high-quality care, Blue Cross Blue Shield of Michigan and Blue Care Network are changing our coverage policy, beginning in 2018, for members in our individual qualified health plans.
If you have an ACA-compliant, individual health insurance plan from BCBSM or BCN:
- If you have an emergency or accidental injury outside of Michigan, your care is covered with in-network cost sharing.
- Any non-emergency services you schedule and receive outside of Michigan from a participating provider will be covered, but have out-of-network cost sharing applied for BCBSM.
- If there is a referral or prior authorization for an out-of-state service, the service will remain subject to in-network cost-sharing.
- Many providers along Michigan’s borders participate in BCBSM and BCN networks. Primary care doctors that participate with us have a Michigan Provider Identification Number. These out-of-state providers will continue to be treated as a participating provider and in-network cost-sharing will apply.
In-network, out-of-network, in-state, out-of-state – we get it. Sometimes, insurance rules can be confusing and frustrating. This is why you always can call the number on the back of your ID card if you have a coverage question. We are here to help.
We want to take care of our members and provide access to quality, affordable health care. And we want them to know the rules of the road – before they hit the road. Travel safely this holiday season, and all the days ahead in the New Year!
can you tell me were to find a list of in network providers in Arizona?
Hi Dave, you can search for network providers here: http://www.bcbsm.com/index/find-a-doctor.html. Thanks, Taylar
I received an email with this notification on Dec. 14, ONE DAY before the end of open enrollment. The initial notices from BCBSM and Healthcare.gov cryptically referred to this change, but after numerous calls to BCBSM, I never got a thorough explanation. And I was never referred to this blog post. Out-of-state care is crucial for many patients with rare diseases. In addition, many BCBSM customers have chosen their coverage because, until now, it included in-network coverage of services from providers such as the Cleveland Clinic, the Mayo Clinic, MD Anderson and others. I find it not a little suspicious that BCBSM has decided to delay sending out by email an explanation to its customers of this change until the penultimate day of open enrollment.
Hi Richard, we are sorry to hear your frustrations. If you would like to speak with someone about the network for your specific plan we would be happy to have someone contact you. If you click this link and give us a few details: http://miblues.co/1Bb6oI4 someone from our team will be in touch. Best, Taylar
I live approx 8 miles from the nearest hospital, it is in Elkhart IN, we were all told we could keep our existing doctors, hospitals, providers etc…… under Obama Care!!!!! All that has happened is, our premiums continue to increase, we can’t use the providers we know, and that know our specific needs relating to our health care!!!! We currently use exclusively Beacon Health Systems for all of our health care and now you tell me they are out of network!!! What the #*%% is going on? I pay you now $1586.00 per month with a $14200.00, family deductible , I will do the math for you; $19032.00 in premiums plus $14200.00 in deductibles before BCBS of Michigan pays anything!!!!
Truly pissed and outraged at this point!!!!
Hi Kent, we apologize for the frustration. If you would like us to have someone call you to discuss your coverage, please provide us with some information here: http://miblues.co/1Bb6oI4 and a member of our team will get in touch with you. Thank you, Taylar
“Affordable” healthcare???!!! Are you joking??
In the past 2 years my “affordable” health care gone up $500 a month, deductible up from $1,400 to $2,000 and to top it off you send me a letter 5 days ago to tell me the insulin I’ve used for 15 years, will no longer be covered by BCBS!!
I’m 53 years old and have had BCBS cover my healthcare for 53 years, up until today! Done w being robbed so that others can enjoy all the Obama subsidies.
Hi Sheri,
Thank you for being a lifetime Blue Cross member. We’d hate to see you go and would like the opportunity to look into your coverage options. If you could provide us with a few pieces of information here, http://miblues.co/1Bb6oI4, someone from our team will reach out to work with you directly.
Thank you,
Taylar
I live in Michigan and my Dr’s are in Indiana that’s why I need the out of state coverage all my Dr’s are in Indiana as a matter of fact it’s just way closer for me
Hi John, many doctors near Michigan’s borders are in-network. Please allow us to look into this situation for you. If you could provide us with some additional information here: http://miblues.co/1Bb6oI4, a member of our team will reach out to you directly. Thank you, Taylar
really? you make this change the day before sign up deadline? how can we possibly make informed decisions with a major change like this… I am currently a cancer patient being treated out of state, which is the closest cancer center to me, as I am on the Michigan border.
How can you help me? My rate is already going up 40%.
Hi Charlie, many doctors near Michigan’s borders are in-network. Please allow us to look into this situation for you. If you could provide us with some additional information here, http://miblues.co/1Bb6oI4, someone from our team will reach out to work with you directly. Thank you, Taylar
Could you define “ACA complaint”? I have a family member who is self employed and signed up through an agent for the Blue across Premier PPO Silver plan but they are uncertain if they specifically purchased this plan through the Affordable Care Act or if this would fall under the “ACA Compliance” standard. Thank you.
Hi Beth, To better answer your family member’s specific coverage questions, please call us at 1-877-4MY-BLUE (469-2583) or visit http://www.bcbsm.com/myblue. Since today is the last day of open enrollment, you may experience longer than average wait times. But enrollment ends at midnight tonight, so we want to ensure we get your questions answered before then.
Well I guess I am not the only one upset about this last minute change, this unfair and totally wrong!!!!! I live in Michigan and Wisconsin is across the street we have no doctors in the upper up that are close, and because of my desease I have to spend time in Florida during the winter cold months and now I can’t go see a doctor in Florida even though they are in your network, I have a 7000$ deductible on top of monthly payments!
Why do we need you, you don’t cover anything. So I will be canceling my insurance Ali g with all my family friends and a million other people!!! So guys are terrible for doing this
Hi Christine,
We truly value you as a member and would like to help you find the care you need. If you could provide us with a few pieces of information here, http://miblues.co/1Bb6oI4, someone from our team will reach out to work with you directly.
Thank you,
Taylar
I also reside right over the Indiana state line and my nearest providers are all in Indiana. I have already spoken to Elkhart General Hospital as well as my PCP. Both of them advised me that they were unaware that BCBSM/BCN was making this change. Both also informed me that they do not have a “Michigan Provider Identification Number”, because all of their cliams with BCBS are handled through BCBS billing in Indiana & they have always been In Network for MI patients.
So now, I am without my PCP and I have ZERO good hospitals near me. You expect me to drive all the way to Kalamzoo, MI or Grand Rapids, MI in order to check in to a good hospital that is In Network on my PPO Plan?
Wouldn’t it have made sense to think about your policy holders who live along the borders of neighboring states and allow those residents the flexibility to seek care with their nearest provider, which in my case is in Indiana? Why couldn’t BCBSM take a proactive approach with doctors & hospitals who are in neighboring states to renegotiate contracts?
Taylar, please don’t post suggesting BCBSM may be able to help me. I spent hours & hours yesterday after I received my email notification speaking to my PCP, other doctor’s offices, clinics & various Indiana hospitals in the Michiana area. Not one of them was aware that without a “Michigan Provider Identification Number“, they are an “Out Of Network” provider effective 1-1-18. And not one of them had a “Michigan Provider Identification Number”.
Hi Diane, We apologize for the confusion around your out-of-state coverage and understand your frustration. We’d like to contact you and help resolve the issues you’re experiencing in this process. If you provide some additional details here, http://miblues.co/1Bb6oI4, a member of our team will reach out and help you get the information you need. Thanks, Taylar
If I”m reading this correctly, does that mean that any in Network participating specialist provider practicing in Ohio will only be covered with out of network cost sharing and deductable?
Hi Edward, many doctors near Michigan’s borders are in-network. To better answer your question, please provide us with some additional information here: http://miblues.co/1Bb6oI4, and a member of our team will reach out to you directly. Thank you, Taylar
After reading this…I’m still not sure if I am ill, ( flu, sinus infection etc) while out of state OR or CA and I go to a BCBS Dr. (not ER) that is listed in the BCBS directory…will it be covered as an in- network provider? I thought the whole idea of coverage, is if you choose a Dr. listed online as in-network, it would be covered.
Please explain.
Thank you.
Hi Debra, Thanks for reaching out. We’d like to get in touch to answer your questions about out-of-state coverage and help you locate an in-network doctor. If you provide some additional background here, http://miblues.co/1Bb6oI4, a member of our team will reach out directly. Thanks, Taylar
Last minute notice, not even sure of all the details, and it is too late to change insurance, as the open enrollment has closed.
Clearly, BCBS does not even know what they are doing to us, per my telephone call on Friday. They will “have to check the status and see what is going on. I will call you back Tuesday.”
Well, so much for the promised call back.
I have been in contact with BCBS of MI 3 times and each time I have been told a different answer. Response 1 – “If you remain within a 100 mile radius and see providers listed in our directory, you will be fine”.
Response 2 – “Even IF they are listed in the directory as in-network, if they are out of state, they ARE NOT in-network”. (My question is how can you list them as in-network and pay claims out of network. There are many many Ohio (Toledo) hospitals listed, but I was told they would be paid as out of network)
Response 3 – “This would not be a qualifying event because we notified members on 12/14/2017 and that was before open enrollment closed” ONE DAY???
Hi, Joseph. We apologize for the frustration. If you can please provide us with some information here: http://miblues.co/1Bb6oI4 a member of our team will reach out to help answer your questions. Thank you, Taylar
Help! We have been BCBSM members for years….even with high premiums and huge deductibles, we need specific care for my husband (out of state) and with the change and the deductible……just HIS cost would exceed $25,000…..now add in just a premium for me and that tacks on an additional $10,000+.
WHERE can i get the Out-of-State Exception Form PLUS what is needed for Appropriate Referral or Prior Authorization.
Hi Shelly, We’d be happy to help and would like to connect you with a member of our team to do so. Please provide us with a couple more details here, http://miblues.co/1Bb6oI4, and we’ll follow up directly to continue the conversation. Thank you, Taylar
where is the authorization form for out-of-state services? the december 15th letter did not include a copy of the form, nor did it have a link for an electronic copy.
Hi Fred, Apologies for that. If you could please share this request with us here: http://miblues.co/1Bb6oI4, someone from our customer service team can reach out to help with this. Thanks, Taylar
I would like to speak to a BCBS representative in regards with my insurance coverage. I am currently a BCBS member with Cobra benefits. I would like to discuss my options once my Cobra benefits expires. Thank you
Hi Mary, Thanks for reaching out. If you provide us with some info here, http://miblues.co/1Bb6oI4, a member of our team will reach out to you to discuss your options and answer any questions. Thanks, Taylar