What do I need to know about the different Blues networks?

Who is this for?

Michigan Health Insurance – Customer Service – Learn More

This page gives you information about our networks that will help when you need to choose a doctor or hospital.

A network is a group of doctors and hospitals that accept a certain health insurance plan. Knowing what your network is and how it works is important. You’ll choose your doctors based on who is part of your plan’s network.

PPO network

Our Premier and Multi-State with Dental and Vision plans have a PPO network. So do most of our Blue Dental plans. That means you can take advantage of the largest network of providers and hospitals in Michigan.

You can choose any doctor or dentist you want, both in- and out-of-network, and still be covered. But you’ll pay less when you go to a health care professional or facility in our network.

HMO networks

We have different HMO networks throughout the state. Some are broad and include doctors and hospitals in almost every county in Michigan. Others are small and based in a certain geographic area. They're called local health insurance networks.

For example, with our Preferred plans, you have access to our entire HMO network, which includes doctors and hospitals in all but 10 Upper Peninsula counties. Some plans have smaller networks because they're limited to certain regions. These are usually our Local, Metro and Partnered plans.

When you have an HMO plan, you choose a primary care physician from your plan's network. They coordinate your care and refer you to specialists in the network.

If you have a Metro Detroit HMO, you'll need to select a primary care physician who participates in that network. The Metro Detroit HMO is part of our larger HMO network. For any care within the extended network, you'll need approval from your physician and plan.

HMO plans don't cover care outside the network, except in an emergency.

EPO network

Our Metro Detroit EPO plans have an EPO network. EPO stands for Exclusive Provider Organization. You choose the doctors you want to see from the Metro Detroit EPO network in Livingston, Macomb, Oakland, St. Clair, Washtenaw and Wayne counties.

Care you get outside the network isn't covered unless it's an emergency or you get special approval from your plan. You can find a doctor or hospital in your network at bcbsm.com.

Staying in your plan's network

No matter which plan you have, the best way to make sure a doctor is in your network is to call and ask them. And don't just tell them you have Blue Cross. Make sure you give them the name of your specific plan and network.

You can read more about the difference between HMO, PPO and EPO plans in our Help Center. And you can get even more detailed information about each network, including a list of participating hospitals, when you’re shopping for individual and family plans.