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What Is a PPO?

 

Why PPO Is a Good Choice

If you like having the flexibility to choose the doctors, hospitals and other health care providers you use to get care, and you can afford to pay more, PPO insurance may be the right plan for you and your family.

PPO plans let you choose where you go for care, without needing a referral from a primary care provider (PCP). They typically have higher monthly premiums than HMO plans. At times, a PPO plan has a larger and broader network of providers.

A PPO may be a good choice for you because:

  • You don't need a PCP to coordinate your care.
  • You don't need a referral to see a specialist.
  • You want a broader network of doctors and facilities.

Often, you can get care from in-network or out-of-network providers but pay more for out-of-network care. However, some PPO plans do not cover care from out-of-network doctors or hospitals so be sure to check your benefits.

Finding Providers in the PPO Network

To make sure a provider is in your plan's network, learn about our Find Care tool. This tool allows you to find the doctors, hospitals and other providers covered by your plan.

If you're a BCBSMT member, register or log in to  Blue Access for MembersSM, our secure member website, for a personalized search based on your health plan and network.

How to Use Your PPO

  • Before you go. You may need to get prior authorization (or pre-approval) from BCBSMT before getting certain tests or services. Your doctor's office will call the prior authorization number listed on your BCBSMT member ID card to confirm. You can also call before you go for care to confirm authorization.
  • For non-emergencies.  For a common illness or injury, like a cold, flu, minor cut or burn, you have a few  options to get care. Learn where to go .
  • In an emergency. When your injury or illness is serious or life-threatening, call 911 or go to the nearest emergency room. You won't have to pay out-of-network costs if it is an emergency. Not sure what’s an emergency? Learn more.
  • For specialists, behavioral health or hospital care.  You do not need a referral to see a specialist or behavioral health care provider. 

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