None of us want to spend money if we don’t have to. That’s why it’s important to understand how your health plan works, so you can get the most benefit from your plan and avoid unnecessary out-of-pocket expenses.

Following are answers to some frequently asked questions about the BlueChoice PPO plan to help you understand your benefits. If you have any other questions, please call the Customer Service number on your member ID card. We’re here for you.

Q: How can I control my out-of-pocket costs?
A: BlueChoice offers you the freedom to choose any doctor and hospital for care. However, your share of the cost for services will be the lowest if you receive care from physicians and providers who participate in our extensive Preferred Patient Care (PPC) network. If you choose to receive care from a physician, provider or hospital participating in our Traditional provider network, you’ll have slightly higher out-of-pocket costs. You’ll pay the most when receiving services from providers outside these networks.

Understanding Your Choices

PPC Network
Lowest costs
No balance billing
No claims filing

Traditional Network
Higher costs
No balance billing
No claims filing

All Other Providers
Highest costs
Can be balance billed
May need to file your own claims

Q: How can I learn if a provider participates in the network?
A: You can check a provider’s network participation on our website at www.bcbsfl.com under “Find a Doctor or Hospital.” We try to keep our online provider directory as current as possible, but we strongly recommend you also confirm network participation when you schedule an appointment.

Q: How can I avoid being billed by my doctor for an outstanding balance?
A: You can free yourself not only from balance billing but also from claims filing by seeking services from providers participating in the PPC or Traditional networks. These doctors and providers can charge only the amount they have negotiated with us; they cannot bill you for any covered services over the allowed amount. You are, of course, responsible for any deductibles, noncovered services and your regular copayment or coinsurance amount, depending on your plan. If you receive a bill from a provider in the PPC or Traditional network for any other charges, please contact Customer Service at the number on your health plan ID card.

Q: What's the difference between an emergency room and an urgent care center?
A: If you’re experiencing a life-threatening condition (can’t breathe, broken bone, head trauma, heart attack symptoms), go to the nearest hospital emergency room. If your condition isn’t life-threatening and your doctor’s office is closed, go to a participating urgent care center. These walk-in clinics offer late and weekend hours and can significantly reduce your out-of-pocket costs compared with a hospital emergency room; your copayment will be the same as if you saw a family physician. Consult our online provider directory at www.bcbsfl.com or call the telephone number listed on your health plan ID card to locate your nearest participating center.

Q: If I have an emergency and go to the hospital, do I need to do anything?
A: You are responsible for paying the ER per-visit deductible, which is in addition to the calendar-year deductible and coinsurance. This applies to emergency room services in or out of the state of Florida. If you are admitted to the hospital at the time of the emergency room visit, the ER per-visit deductible is waived.

Q: If I get sick when I’m out of town on business or vacation, am I covered even if it isn’t an emergency?
A: The BlueCard® Program gives you access to participating providers of independent Blue Cross and Blue Shield organizations throughout the country and around the world. And, to make it even easier, you won’t have any claims to file and there are no billing hassles down the road. You can locate nearby doctors and hospitals on the BlueCard Doctor and Hospital Finder website at www.bcbs.com, or call BlueCard Access at (800) 810-BLUE [2583]. When you arrive at the participating doctor’s office or hospital, present your health plan ID card. You are responsible, of course, for the cost of your usual out-of-pocket expenses (noncovered services, deductible, copayment and/or coinsurance).

Q: If I need laboratory testing, do I have to go to any specific lab?
A: We have an extensive network of participating laboratories all over the state. To locate the nearest facility, consult our online provider directory at www.bcbsfl.com, or call the telephone number listed on your health plan ID card.

Q: Can I use the Internet to communicate with my doctors?
A: Yes, if you and your doctor have signed up for our e–Medicine program. Blue Cross and Blue Shield of Florida is the first health plan in the state to offer you totally secure and confidential Internet access to your doctors for nonurgent medical conditions. Hundreds of doctors are already participating. If your doctor’s office is participating, you can schedule or change an appointment, ask a simple question, receive lab and test results and request medication refills when it’s most convenient for you—any time of the day or night.

Depending on your particular plan, you also may be covered for an online medical consultation, or webVisit®. If so, you will pay the same out-of-pocket amount as you would for a face-to-face office visit with your doctor. Your doctor may not complete the online consultation if he or she decides you need to be seen.

To sign up for the service, go to our website, www.bcbsfl.com, and click on Members, then Products, Plans & Services, and e–Medicine.