Understanding Individual Plan Coverage Outside of Michigan

by bcbsm

| 2 min read

three tall skyscrapers
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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35 Comments

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Blues Perspectives

Apr 19, 2022 at 8:25pm

We’d be happy to help answer any questions about your daughter's coverage. If she could provide us with some additional information at this link, a member of our team will reach out to her directly: https://www.mibluesperspectives.com/customer-action-center/

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Blues Perspectives

Apr 19, 2022 at 8:10pm

Hi Lisa. We strongly recommend using the Find A Doctor tool on our website to see if there is anyone in the area available to provide the care that you need. We'd also recommend calling the number on the back of your card to discuss potential coverage options.

m
madeltuckerine

Apr 16, 2022 at 7:37pm

my daughter visiting in texas needs a hystrectomy and was reccomended a dr. frederick cummings. does he accept michigan blue cross ppo individual for payment or is he out of network?

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Lisa Ann Armbrust

Jan 27, 2022 at 9:52pm

Something seriously needs to be done. I haven't had a mammogram in 3 years because I am unable to travel 1-3hrs. in the Upper UP. I live on the MI Wi border and if I had coverage could travel 5 min. to have this done. My husband is also unable to seek medical attention for his rheumatoid arthritis for the same reason. We have no choice but to not seek medical attention until it is a emergency. Not to mention we have no choice who we have cover us.

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Blues Perspectives

Jan 19, 2019 at 12:52am

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

MI Blues Perspectives is sponsored by Blue Cross Blue Shield of Michigan, a nonprofit, independent licensee of the Blue Cross Blue Shield Association