What makes Premier Blue Access Option different from other health care benefits programs?
Premier Blue Access Optionwas developed in response tocustomer demands for a more flexible managed care program. Our members told us they liked having a primary care provider as their partner in health care. They also told us they wanted freedom of choice when it came to receiving services from other health care providers.
Will I need to get a referral if I want to see a doctor other than my PCP?
No. You have the freedom to access medical care directly from any provider without a referral. No matter where you seek care you will be covered. However, the amount of payment for covered services will depend on the network choices you make — inside the network, outside the network or non-contracting. You choose the level of benefits you receive.
What is the incentive to receive care from Premier Blue network providers?
There will be a significant difference in benefit payment levels should you seek care from a non-network or non-contracting provider. When you receive services from Premier Blue network providers, you will receive the highest level of benefits available under the program. Also paid at this maximum level are medical emergency services and services received from BlueCard® network providers. (BlueCard is a nationwide network of BCBS contracting providers located outside the Access Option enrollment area.)
What if I receive care from an out-of-network provider?
If you seek care from a provider that is not in the Premier Blue network within the Access Option enrollment area, you still have coverage. Benefits will be paid at the out-of-network benefit level, subject to a separate deductible and coinsurance amount.
What if I receive care from a non-contracting provider?
If you seek care from a noncontracting provider, (one that does not contract with a BCBS Plan) benefits will be paid at the out-of-network benefits level. You will be responsible for any difference between our payment allowance and the provider’s charge and an additional 20 percent coinsurance amount.