What's Blue Cross^® Physician Choice PPO and how does it work?

Having one doctor who manages your care reduces health care costs.

When that doctor is part of a community of doctors and hospitals -- called an Organized System of Care, or OSC -- that meet standards for quality and lower costs, it reduces costs even more. With Blue Cross Physician Choice PPO, you can choose to take advantage of these savings if you live in one of 64 Michigan counties.

Primary care physicians

When you have Physician Choice PPO, your share of the costs for care will be much lower if you choose to:

• Select a primary care physician in a Level 1 OSC
• See that primary care physician first to coordinate your care
• Go to doctors and hospitals in your selected OSC
• Get a referral from your primary care physician before using doctors and hospitals outside your selected OSC

You can have one primary care physician, or PCP, for everyone on your plan, or each person can have their own. How do you find primary care physician in Level 1 OSCs? The easiest way is online, where you can filter by eligible primary care physicians and OSCs. Find a doctor.

Remember, it's all up to you. When you enroll in Physician Choice PPO, you don't have to select a physician at all. If your current physician isn't in a Level 1 OSC you can choose to keep seeing that physician, or you can select a physician who isn't in a Level 1 OSC. Your share of the costs, however, will be higher as a result. 

Cost share levels

Physician Choice PPO plans have different cost share levels that are based on where and how you choose to get care. Cost sharing is when you and your plan help pay for your care. It includes your deductible, coinsurance and copays. 

Here's how the cost share levels work.

Physician Choice deductibles are different

A deductible is the amount you pay for health care services before your health insurance begins to pay.

PPO plans usually have two deductibles—in network and out of network—but you only pay toward one at a time. Physician Choice is different:

• If you get care that results in Level 2 cost share, what you pay goes toward your Level 2 and your Level 1 deductible
• If you get care from a physician who doesn’t take Blue Cross, what you pay goes toward all your plan’s deductibles—out of network, Level 2 and Level 1

Why does this happen? The sooner you reach your Level 1 deductible, the sooner you can save. You do that by choosing a primary care physician in a Level 1 OSC, and letting that physician and other high-performing providers in the OSC manage your care.

Exemptions

Spouses and dependents on your plan who live outside the plan's area can still save. With an exemption, they can get Level 1 cost share from any physician or hospital in the U.S. that is in the Blue Cross network. Contact your employer to ask for an exemption.