Our PPO managed health care plans provide for the payment of benefits at a higher level of coverage when the member utilizes our network of preferred providers. These network providers, including physicians, specialty care providers, hospitals, and other health care facilities and practitioners, have contracted with BCBSTX to provide health care services at negotiated rates.
Search for Doctors, Hospitals and Dentists Blue Cross Blue Shield members can search for doctors, hospitals and dentists. In the United States, Puerto Rico and U.S. Outside the United States. Select Blue Cross Blue Shield Global™ or GeoBlue if you have international coverage and need to find care outside the United States. Her plan requires a $25 copay for the visit. Mary pays the $25 copay to the receptionist when she arrives for her appointment. During her office visit, Mary’s doctor sends her to the lab to have blood drawn.
If the member elects to receive care from network providers:
- Arkansas Blue Cross and Blue Shield: Bronze Plan 1 PPO Coverage for: Individual/Family Plan Type: PPO 1 of 6 The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. The SBC shows you how you and the plan would share the cost for covered health care services.
- To Blue Cross and Blue Shield Member ID Cards A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association. PPO in a Suitcase PPOB in a Suitcase No Suitcase Medicare Advantage Consumer-Directed Healthcare and Healthcare Debit Cards Introduction This guide.
- They will receive the higher level of benefits (In-Network Benefits)
- They are not required to file claim forms — Network providers bill BCBSTX for services provided
- They are not balance billed — Network providers will not bill for costs that are in excess of the BCBSTX allowable amount for covered services.
- Network providers are responsible for any necessary preauthorization
If the member elects to receive care from providers outside of the network, they may choose:
| ParPlan Providers Providers participating in a direct-payment arrangement with BCBSTX | Out-of-Network Providers Non-contracting providers |
|---|---|
If the member elects to receive care from a ParPlan Provider, benefits for covered services are available at the lower level of benefits (Out-of-Network); however…
| If the member elects to receive care from a non-contracting provider, benefits for covered services are available at the lower level of benefits (Out-of-Network); and…
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The PPO plan is available to clients through the Blue ChoiceSM Network, one of the largest networks in Texas. Blue ChoiceSM provides:
- Access to the national BlueCard® network when members are outside of Texas
- Over 600 participating hospitals and facilities in Texas
- More than 800,000 doctors and 6,000 hospitals contracting with Blue Cross and Blue Shield plans nationwide
For health care services required outside of Texas, members have access to the BlueCard national network of providers.
BCBSTX offers a variety of PPO plans with varying deductible, coinsurance and copayment amount options. All plans include an outpatient prescription drug benefit with either a three-tier or four-tier pharmacy copay design.
The three-tier pharmacy copay plan design includes three tiers of medications that are comprised of:
- Generic Drugs
- Preferred Brand-name Drugs
- Non-preferred Brand-name Drugs
The four-tier pharmacy copay plan design includes four tiers of medications that are comprised of:
- Generic
- Preferred Brand-name Drugs
- Non-preferred Brand-name / Preferred Specialty
- Non-preferred Specialty Drugs
Prescription drugs are available through retail pharmacies throughout Texas and mail order pharmacy services.
Blue Cross Blue Shield Ppo Providers
Blue Cross Blue Shield National Ppo Network
For more detailed information on available benefit designs, a description of the services and supplies that are covered, a listing of those services and supplies that are limited or excluded, terms and general administration or for any questions you may have regarding our products and services, contact us for the phone number of the regional sales office near you.
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