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Understanding Individual Plan Coverage Outside of Michigan

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!

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