Premera Blue Cross Blue Shield of Alaska
Alaska • HMO, PPO, EPO, HDHP, Medicare Advantage, Vision
HMO (Health Maintenance Organization) plans require members to choose a primary care physician (PCP) and obtain referrals before seeing specialists. Out-of-network services are generally not covered except in emergencies. Claims must be submitted to the payer listed above and should include referral authorization when applicable.
This prefix is associated with a PPO plan. Preferred Provider Organization coverage gives members flexibility to see specialists without referrals and to use out-of-network providers at higher cost-sharing. Claims can be submitted for both in-network and out-of-network services, though reimbursement rates differ.
EPO (Exclusive Provider Organization) plans require members to use in-network providers, similar to an HMO. The key difference is that referrals are usually not required to see a specialist. Out-of-network care is not covered except in emergency situations. Submit claims to the payer listed above.
HDHP (High-Deductible Health Plan) coverage means the member has a higher deductible than traditional plans, often paired with a Health Savings Account (HSA). Most services require the member to pay out-of-pocket until the deductible is met. Preventive care is typically covered before the deductible. Submit claims normally to the payer listed above.
Under this prefix, the member may have Medicare Advantage coverage administered by this BCBS plan. MA claims are subject to CMS regulations in addition to the plan's own policies. Balance billing restrictions apply. Verify the member's specific MA plan details and confirm the correct payer ID for electronic submission.
Premera Blue Cross has operated in Alaska since 1957. Serves over 500,000 members. Part of the Blue Cross Blue Shield Association.