Practitioners must sign contracts soon to participate in the Southeast Michigan local network

Practitioners interested in participating in a new local exclusive provider organization network for Southeast Michigan individual members need to sign and return the contract signature document soon.

Blue Cross Blue Shield of Michigan is developing a local exclusive provider organization network for health insurance products to be marketed to individuals in selected Southeast Michigan counties: Lenawee, Livingston, Macomb, Monroe, Oakland, St. Clair, Washtenaw and Wayne. We plan to introduce these local products in 2015 for individual consumers on and off the Health Insurance Marketplace.

Contracts were distributed to practitioners in these counties in October and November. Additional copies are available from your BCBSM provider consultant, who can also answer any questions regarding this opportunity.

BCBSM requested that signature pages be returned by Dec. 31, 2013. Practitioners who are interested in joining the EPO network and have not yet responded should immediately fax the signature document to BCBSM at 1-866-915-1714 or email a scanned and signed copy to SE_Michigan_EPO@bcbsm.com. This will indicate your participation in the EPO network, pending final BCBSM approval.

Physicians (M.D. and D.O.), podiatrists, chiropractors, oral surgeons and fully licensed psychologists participating in our TRUST PPO network are eligible to participate in the new EPO. Practitioners must also meet network selection standards, which were published in the Detroit Free Press in August before physician contracting began.

How are these products different?
BCBSM is committed to providing solutions for the estimated 600,000 uninsured in Southeast Michigan and other consumers who want locally driven, quality health care at a reasonable price. The Michigan Blues are looking to create partnerships with health care providers who are willing to control costs in order to provide access to affordable coverage. 

These EPO products will not offer out-of-network coverage (except for emergency services), and members who receive care from providers not in the EPO network will be required to pay in full for those services. 

Participating in the EPO network will give practitioners an opportunity to provide services to members who purchase these products. Services provided as a part of this network will be reimbursed in accordance with a published fee schedule that will be set 10 percent lower than TRUST payment rates. Please note that information in a cover letter sent with the contract addendum to some physicians included an error in explaining this rate. We apologize for any confusion this may have caused.