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


| 2 min read

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 Cost Share = Lowest Costs: Use doctors and hospitals within YOUR selected primary care doctor’s Level 1 OSC* OR, use doctors and hospitals outside of your primary care doctor’s Level 1 OSC but within the PPO network with a referral from your primary care doctor
  • Level 2 Cost Share = Higher Costs: Select a primary care doctor within a Level 1 OSC, but use doctors and hospitals outside your primary care doctor’s OSC without a referral OR, select a primary care doctor not in a Level 1 OSC OR, do not select a primary care doctor
  • Out of Network: Use doctors and hospitals outside the Blue Cross PPO network (referrals for Level 1 cost share are not available outside the PPO network)
*Note: If you’ve selected a primary care doctor in a Level 1 OSC and you use services from another doctor or hospital within that Level 1 OSC, you do not need a referral. 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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Blues Perspectives

Jul 10, 2019 at 2:45pm

Hi Rebecca, If you could send us a little more information here, https://miblues.co/2QJW3zp, a member of our team will reach out and can help you directly. Thanks, Georgia

Rebecca Tobias

Jul 10, 2019 at 8:39am

We have a client that has a Primary Care and OBGYN both Level 1 Doctors, however, it seems that they go in and out of Level 1. When she called BCBSM they stated that she needs to ask each visit whether they are still Level 1. Does this seem right?

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