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December 2014

Online tutorial will walk you through our new individual plans with local networks

In last month’s issue, we announced our 2015 individual products. They include new plans with localized provider networks:

  • Blue Cross® Metro Detroit EPO
  • Blue Cross® Metro Detroit HMO

The Metro Detroit EPO covers six counties: Livingston, Macomb, Oakland, St. Clair, Wayne and Washtenaw. The Metro Detroit HMO covers three counties: Macomb, Oakland and Wayne.

Residents of these counties can now purchase the plans that become effective as of Jan. 1, 2015.

To learn more about the Metro Detroit EPO and HMO, an online tutorial will be available on web-DENIS by Dec. 5, 2014. To view the presentation, log in to web-DENIS:

  • Click on BCBSM Provider Publications and Resources.
  • Click on Newsletters & Resources.
  • Go to the “What’s New” section and click on Training presentation: Blue Cross® Metro Detroit EPO and HMO local networks.

How this affects your practice
Other than eligible emergency services and accidental injuries, patients with these plans may not have coverage if they visit a doctor that is outside the network.

So it’s very important to know if you are in either network to provide services to patients with these health plans. Find out if you’re in the Metro Detroit EPO network, Metro Detroit HMO network or both. And be sure your office staff is also aware of which networks you are in.

Keep the following in mind:

  • Before you provide a service, check your patient’s plan name and network.
  • Refer members to health care providers and hospitals in their networks. You can use the Find a Doctor search feature on bcbsm.com to verify that a doctor or hospital is in this network. We’ve also created a flier with instructions on how to use this tool.

How we’re educating members
We want to ensure a smooth transition for the providers in the Metro Detroit EPO and HMO networks and our members who have these new plans.

To do that, we’re conducting ongoing outreach to educate members how the coverage works for our plans with localized networks. We’re highlighting the guidelines for their local network coverage and the importance of providing you with the complete name of their plan and network when making appointments and at the time of their services.

If you have questions about our local network plans, you can get additional information from your provider consultant.

No portion of this publication may be copied without the express written permission of Blue Cross Blue Shield of Michigan, except that BCBSM participating health care providers may make copies for their personal use. In no event may any portion of this publication be copied or reprinted and used for commercial purposes by any party other than BCBSM.

*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2013 American Medical Association. All rights reserved.
Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and
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