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Important information for:

Medicare Plus Blue Essential, Vitality, Signature and Assure members

Medicare Plus Blue PPO Essential, Vitality, Signature and Assure Plan Members

This directory provides a list of Medicare Plus Blue network providers. To get detailed information about your health care coverage, please see your Evidence of Coverage.

The network providers listed in the Find a Doctor directory have agreed to provide you with your health care coverage. You may go to any of our network providers listed in this directory. If you have been going to one network provider, you are not required to continue going to that same provider. In some cases, you may get covered services from non-network providers.

If you receive medical services within the Medicare Plus Blue PPO service area, most will be covered at in-network levels. Services you receive from out-of-network providers will be covered at out-of-network levels and you will pay more out-of-pocket than if you choose an in-network plan provider, with the exception of emergencies and urgent care.

When you make your appointment, ask your doctor if he or she participates with Medicare Plus Blue PPO or call our Member Services department to find a participating plan provider. Call 1-877-241-2583, 8 a.m. to 8 p.m. Eastern time, Monday through Friday, with weekend hours Oct. 1 through Feb. 14.. TTY users call 711.

If you need out-of-network medical care, you may go to any doctor or hospital that accepts Medicare. To find a doctor or hospital near you, call our Member Services department at 1-877-241-2583, 8 a.m. to 8 p.m. Eastern time, Monday through Friday with weekend hours Oct. 1 through Feb. 14. TTY users call 711.

If you receive care from an out-of-network or non-plan provider, the provider may bill you for the services you receive. Please mail your itemized bill along with your name and contract number to us so we can review it for payment. Mail the information to:

Member Service Inquiry
Mail Code X521
600 E. Lafayette Blvd.
Detroit, MI 48226-2998

If you need emergency care, call 911 or go directly to an emergency room. If you are admitted to the hospital for the same condition within three days of your emergency room visit, you do not have to pay the emergency room copay. Emergency care can always be obtained in or out of the service area from the nearest available provider. You're also covered for emergency and urgent care worldwide. You may have to pay for the care you receive and seek reimbursement from us. See your Evidence of Coverage for more information.

When out of the service area, you can obtain dialysis treatment from any qualified dialysis provider.

What is the service area for Medicare Plus Blue PPO?

The Medicare Plus Blue PPO service area includes all counties in the state of Michigan.

How do you find Medicare Plus Blue PPO providers in your area?

The Find a Doctor directory lists Medicare Plus Blue PPO providers by location, so you can find the providers in your community. You can also check by name, specialty or health issue.

If you need further assistance finding a provider or have questions about Medicare Plus Blue PPO please call our Member Services department at 1-877-241-2583, 8 a.m. to 8 p.m. Eastern time, Monday through Friday, with weekend hours Oct. 1 through Feb. 14. TTY users call 711.

If you need durable medical equipment, prosthetic or orthotic devices, dental care, vision care, outpatient laboratory or fitness services:

  • Your doctor or specialist is responsible for determining your need for outpatient durable medical equipment, as well as prosthetic and orthotic devices and will write a prescription for the equipment. To locate an in-network provider, call Member Services at 1-877-241-2583, 8 a.m. to 8 p.m. Eastern time, Monday through Friday, with weekend hours Oct. 1 through Feb. 14. TTY users call 711.
  • Our dental network includes DenteMax dentists as well as dentists who contract directly with us. You must receive care from a Medicare participating network dentist for the services to be covered at in-network levels. If you're travelling outside of Michigan, you can receive in-network care from any Medicare participating DenteMax dentist. To find a network dentist near you, call our Member Services department at 1-877-241-2583. TTY users should call 711. Representatives are available from 8 a.m. to 8 p.m. Eastern time, Monday through Friday, with weekend hours Oct. 1 through Feb. 14. To find a DenteMax dentist, you may also visit www.dentemax.com.
  • VSP provides your vision care services. VSP's network of doctors is conveniently located in retail, neighborhood, medical and professional settings, and many locations offer early morning, evening and weekend hours. To find a VSP provider near you, call 1-800-877-7195 Monday through Friday, 8 a.m. to 6 p.m., and Saturday from 9 a.m. to 5:30 p.m. TTY users call 1-800-428-4833. Or, go to www.vsp.com.
  • Joint Venture Hospital Laboratories and Quest Diagnostics provide in-network outpatient laboratory services within the Medicare Plus Blue PPO service area. To locate a network laboratory, call our Member Services department at 1-877-241-2583. TTY users call 1-800-579-0235. Representatives are available from 8 a.m. to 8 p.m. Eastern time, Monday through Friday, with weekend hours Oct. 1 through Feb. 14.
  • For Vitality, Signature and Assure plan members, your fitness benefit is provided by SilverSneakers®. To find a participating location near you, call 1-888-423-4632 from 8 a.m. to 8 p.m. Eastern time, Monday through Friday. TTY userscall 711. Or, visit www.silversneakers.com.

Medicare Plus Blue Group members

Medicare Plus Blue Group PPO Plan Members

The FInd a Doctor directory provides a list of Medicare Plus Blue network providers. To get detailed information about your health care coverage, please see your Evidence of Coverage.

The network providers listed in the Find a Doctor directory have agreed to provide you with your health care coverage. You may go to any of our network providers listed in this directory. If you have been going to one plan provider, you are not required to continue going to that same provider. In some cases, you may get covered services from non-plan providers; however, your cost-sharing requirement may increase.

If you need medical care outside of the state of Michigan, you may obtain care from any provider that accepts Medicare and your Medicare Plus Blue Group PPO ID card. If you receive services outside the state of Michigan, in-network cost-sharing will apply for all Medical services (except durable medical equipment, prosthetics and orthotics — see below for more information on how to obtain these goods and services).

To locate a provider outside the state of Michigan, please call Member Services at 1-866-684-8216 from 8:30 a.m. to 5 p.m. Eastern time, Monday through Friday. TTY users call 711.

You're also covered for emergency and urgent care worldwide. You may have to pay for the care you receive and seek reimbursement from us. See your Evidence of Coverage for more information.

If you need emergency care, call 911 or go directly to an emergency room. If you are admitted to the hospital for the same condition within three days of your emergency room visit, you do not have to pay the emergency room copayment.

If you need durable medical equipment, prosthetic or orthotic devices, or outpatient laboratory services:

  • Your doctor or specialist is responsible for determining your need for outpatient durable medical equipment, as well as prosthetic and orthotic devices and will write a prescription for the equipment. To locate an in-network provider, call Member Services at 1-866-684-8216 from 8:30 a.m. to 5 p.m. Eastern time, Monday through Friday. TTY users call 711.
  • Joint Venture Hospital Laboratories and Quest Diagnostics provide your outpatient laboratory services. To locate a network laboratory, call Member Services at 1-866-684-8216. TTY users call 1-800-579-0235. Representatives are available from 8:30 a.m. to 5 p.m. Eastern time, Monday through Friday.

If you receive care from a non-plan provider within Michigan, the provider may bill you for the services you receive. Please mail your itemized bill along with your name and contract number to us so we can review it for payment. Mail the information to:

Medicare Plus Blue Group PPO — Mail Code X521
Blue Cross Blue Shield of Michigan
600 E. Lafayette Blvd.
Detroit, MI 48226-2998

See your Evidence of Coverage for more information regarding how to receive care, or call our Member Services department at 1-866-684-8216 from 8:30 a.m. to 5 p.m. Eastern time, Monday through Friday. TTY users should call 711.

What is the service area for Medicare Plus Blue Group PPO?

Medicare Plus Blue Group PPO is available only to members who live in our plan service area, which includes all 50 states and all territories of the United States. To stay a member of our plan, you must continue living in this service area.

How do you find Medicare Plus Blue Group PPO providers in your area?

The Find-a-Doctor directory lists Medicare Plus Blue Group PPO providers by location, so you can find the providers in your community. You can also check by name, specialty or health issue.

If you need further assistance finding a provider or have questions about Medicare Plus Blue Group PPO, please call our Member Services department at 1-866-684-8216 from 8:30 a.m. to 5 p.m. Eastern time, Monday through Friday. TTY users call 711.


Additional directories

H9572 S5584_W_Apr14BCBSMAdvWeb Pending CMS Approval

Important information about these plans

Medicare Plus Blue and Prescription Blue are PPO and PDP plans with a Medicare contract. Enrollment in Medicare Plus Blue and Prescription Blue depends on contract renewal.

Medicare Plus Blue PPO

Medicare Plus Blue PPO is available to all Medicare beneficiaries who are Michigan residents and are entitled to receive services under Medicare Part A and enrolled in Part B.

With the exception of emergency or urgent care, it will cost more to get care from non-plan or non-preferred providers. Your responsibility will be greater out-of-network when the out-of-network coinsurance is based on the Medicare-allowed amount and the contracted amount is lower. You may receive services from any provider who accepts Original Medicare. Your out-of-pocket costs will be lower if you choose a network provider. To find a network provider, visit http://www.bcbsm.com/medicare/find-a-doctor/.

Prescription Blue PDP

Prescription Blue PDP is available to all Medicare beneficiaries who are Michigan residents entitled to receive services under Medicare Part A and/or enrolled in Part B.

Medicare Plus Blue PPO and Prescription Blue PDP

Premiums vary by county. You must continue to pay your Medicare Part B premium. You may enroll in only one Part D plan at a time.

Limitations, copayments and restrictions may apply.

Our network includes approximately 2,400 Michigan retail pharmacies, representing approximately 98 percent of all Michigan pharmacies. Nationwide, most chain pharmacies are in our network, as well as long-term care and home infusion pharmacies and Indian/Tribal/Urban (Indian Health Service) pharmacies.

In general, benefits are only available at contracted network pharmacies. Plan drugs may be covered in special circumstances; for instance, illness while traveling outside of the plan's service area where there is no network pharmacy. You may have to pay more than your normal cost-sharing amount if you get your drugs at an out-of-network pharmacy. Quantity limitation and restrictions may apply. In addition, you will likely have to pay the pharmacy's full charge for the drug and submit documentation to receive reimbursement from Blue Cross Blue Shield of Michigan. For additional information on network pharmacies, please call Member Services at 1-877-241-2583, 8 a.m. to 9 p.m. Eastern time, Monday through Friday, Feb. 15 through Sept. 30, with weekend hours Oct. 1 through Feb. 14. TTY users call 711. Certain services available 24/7 through our automated telephone response system. You may also write to: Blue Cross Blue Shield of Michigan, 600 E. Lafayette Blvd., Mail Code X521, Detroit, MI 48226.

If you decide to have your plan premium withheld from your Social Security check or deducted from your checking or savings account, it may take up to three months for the automatic deduction to begin. If your premium amount is currently withheld from your Social Security check or deducted from your checking or savings account and you wish to receive a monthly bill instead, the change may also take up to three months to become effective. During this time, you will be responsible for paying your premium.

The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan. Benefits, formulary, pharmacy network, premium and or copayments/coinsurance may change on Jan. 1 of each year.

Medicare beneficiaries may enroll in Medicare Plus Blue PPO or Prescription Blue PDP through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov. BCBSM does not control Medicare's website and is not responsible for its content. You may only enroll in Medicare Plus Blue PPO or Prescription Blue PDP during specific times of the year.

For more information, please contact Blue Cross Blue Shield of Michigan at 1-888-563-3307. TTY users call 711. Hours are: 8 a.m. to 9 p.m. Eastern time, Monday through Friday, Feb. 15 through Sept. 30, with weekend hours Oct. 1 through Feb. 14.

LegacySM Medigap

Legacy Medigap offers access to any hospital, doctor or other health care provider in the U.S. or its territories that accepts Medicare assignment. The plan does not require members to use a specified provider network. Legacy Medigap is a Medigap health insurance policy administered by Blue Cross Blue Shield of Michigan. Neither Blue Cross Blue Shield of Michigan nor agents authorized to sell Blue Cross Blue Shield of Michigan policies are connected with Medicare.