Optimizing Your Plan: Referrals with Blue Cross® Physician Choice PPO


| 2 min read

Blue Cross® Physician Choice PPO offers access to coordinated health care by way of Blue Cross’ Organized Systems of Care (OSC), communities of doctors and hospitals in our expansive PPO network. The result is personalized, coordinated care that gives you lower out-of-pocket costs. OSCs include primary care doctors, specialists and acute care hospitals. If you’ve selected a primary care doctor in an OSC that is designated as Level 1 and you want to use services from a specialist or hospital within that Level 1 OSC you do not need a referral. If you need services from a specialist or hospital outside of your OSC, you’ll need a referral to visit that specialist or hospital—or pay higher out of pocket costs What is a referral? Referrals are electronic orders from your primary care doctor that allows patients to see a specialist based on their specific health care needs. How do referrals work with Physician Choice PPO?
  • Ask your primary care doctor to submit a referral before you receive a service from a doctor or hospital that is outside your OSC, but still within the Blue Cross PPO network.
  • After your doctor submits the referral, you’ll receive a letter from Blue Cross once the referral is approved.
  • The letter will have the name of the doctor that submitted your referral, the name of the doctor or hospital you’ll be going to for care and the time frame to schedule your visit.
  • You’ll also be able to see all your referral information, if your referral has been approved, and print letters by logging into your account at bcbsm.com.
  • Your referral is valid as long as the doctor or hospital you use is where you were referred, your service was received within the Blue Cross PPO network, and your visit was within the time frame noted on your referral.
For more information on Blue Cross® Physician Choice PPO visit, PhysicianChoicePPO.com.

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Anna A. Bakos

Jan 27, 2017 at 10:00pm

You have made everything so complicated & obviously for a desire to completely control the process. Insurance companies are making life miserable for customers. And, while most products le will not say what I will say, " you are taking hours & hours of our lives just to operate with the system. Do you realize how this removes days of our lives that are gone forever & could have been used to spend in more satisfying ways?! Life is short & you are making our senior years weary, angry & advancing swiftly toward our demise! I am certain no one thinks this way in business. As my former husband often said,(who has been on the Board of a well-known local hospital for 40 years,) "People are living longer & longer, having more & more health issues, healthcare will soon run out of my money." As I often asked, "Do you know of anyone who will volunteer to bow out of this life sooner than later, to solve this problem"? I think this last comment sums up the way many of your customers feel!

Anna A. Bakos

Jan 27, 2017 at 9:43pm

Does this mean that I will have to use the particular physician & hospital the primary care physician is referring me to? What if I have heard not such good things about the he physician to whom I've been referred. If I do not wish to see the doctor to whom I've been referred, can I choose another physician as long as that physician is 'in network'? Also , there is a particular hospital that several of my associates & I will no longer Choose to use; are we restricted from going to the hospital of our choice that is in network? These are important issues. Please make sure they are addressed .

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