Are out-of-network benefits covered?

Who is this for?


If you're a BCN AdvantageSM member, this information will tell you whether you're covered if you get care outside your plan's network.

When you have an HMO or HMO-POS plan with us, you're agreeing to see doctors who are in your plan's network. Your primary care physician will coordinate all your care, and find the right in-network specialists for you. 

For the most part, we won't cover care you get out of our network. But there are a few exceptions.

When out-of-network benefits are covered:

  • You have a medical emergency.
    If you’re having chest pain or another medical emergency, it’s important that you get care as soon as possible. You should go to the closest emergency room or urgent care center. 
  • You need medical care that you can’t get from a doctor in your network.
    If you need treatment that you can’t get from a doctor in your network, you can go to an out-of-network doctor. But you’ll need to get special approval from us first. Usually, your doctor will be able to request that approval for you.
  • You’re traveling and you need kidney dialysis.
    If you need dialysis and you travel to an area where there are no in-network dialysis centers, you can go out of network. You’ll need to get approval from us first.
  • When you're traveling.
    Our HMO-POS plans have a national network of Blue Cross doctors. You can make arrangements to see a doctor that's out of your plan's network but in our nationwide network when you’re traveling outside of Michigan. To find a doctor call the number on the back of your ID card.