EPO (Exclusive Provider Organization)
The EPO (Exclusive Provider Organization) plan delivers in-network-only benefits through the national BlueCard® PPO network. Our BlueCard PPO network links participating doctors and hospitals to Blue Cross and Blue Shield Plans throughout the United States, providing a nationwide network of doctors, hospitals, and other health care professionals. More than 600,000 physicians and over 6,000 hospitals participate in the network, the largest health care network in the nation.
EPO members must seek care from participating BlueCard PPO providers, except in the case of a life- or limb-threatening emergency. If care is received from a nonparticipating provider, there is no benefit coverage. It is the member’s responsibility to confirm that the providers and specialists they are seeing participate in the network. Claims will not be paid if care is received from a provider who is not in the network.
Do I need to choose a PCP?
With the EPO plan, members do not need to select a Primary Care Physician (PCP), and referrals are not needed to access specialty care. Members can access any network doctor or hospital at any time and enjoy the in-network level of benefits. Care must be received from participating BlueCard PPO providers, except in the case of a life- or limb-threatening emergency.
Easy Service—No Hassles
When using BlueCard PPO doctors and hospitals, members have no claim forms to file and virtually no paperwork. All BlueCard PPO providers will handle all of the paperwork for them. Plus, Horizon BCBS offers toll-free customer service Monday through Friday, 8 a.m. to 6 p.m., Eastern Standard Time, so members can get the help they need when it’s convenient for them. Members also have access to our interactive Member Web site, where they can look up claim status and enjoy other online services designed to make their health care experience more satisfying.
Finding in-network doctors and hospitals
Members can access BlueCard PPO network doctors and hospitals several ways. Members can access information about network providers, including directions to their location with the National Doctor and Hospital Finder. Members can also call the BlueCard Access Line at 1-800-810-BLUE (2583) to access PPO providers. If you are not yet an enrolled member, indicate that you are not yet enrolled but are considering becoming a member.
Portable Benefits Coverage
The BlueCard® PPO program links you directly to care anywhere in the country and in the world. So, whether traveling or living in another state, members can take advantage of their benefits by presenting their ID cards to any participating doctor or hospital. Once enrolled, members simply carry our easily identifiable ID cards with a PPO in a suitcase logo, which lists a toll-free number to help reach a BlueCard PPO provider.