HMO coverage means this member must use providers within the plan's network. A primary care physician serves as the care coordinator and must authorize specialist referrals. Emergency services are the primary exception to the network requirement. Always verify referral status before providing non-emergency specialty care.
EPO coverage under this prefix means the member must use network providers but does not need referrals for specialist visits. This plan type is becoming more common as it offers lower premiums than PPO plans while providing more flexibility than HMOs. Verify network status before providing services.
This is a Preferred Provider Organization (PPO) prefix. PPO plans are the most common BCBS plan type. Members have the freedom to self-refer to specialists. Claims for in-network services are typically processed faster and reimbursed at higher rates than out-of-network claims.
Nonprofit health insurance company serving seven million members nationwide with strongest presence in Philadelphia area and Southeastern Pennsylvania. Member of the Blue Cross Blue Shield Association for over 85 years.