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February 2015

Reminder: Metro Detroit EPO, HMO networks

As a reminder, the Blue Cross® Metro Detroit EPO network covers six counties in Southeast Michigan (Livingston, Oakland, Macomb, St. Clair, Wayne, and Washtenaw), while the Blue Cross® Metro Detroit HMO covers three counties (Macomb, Oakland and Wayne).

Other than eligible emergency services and accidental injuries, members who have enrolled in a Metro Detroit EPO do not have coverage if they visit a doctor or hospital that is outside the network. Be sure to always refer members to health care providers that are in the network.

For care outside the local Metro Detroit HMO network, keep the following guidelines in mind:

  • If the service is in the statewide BCN provider network, standard BCN referral and clinical review requirements apply.
  • If the service is outside the BCN provider network, BCN out-of-network rules apply. (Providers submit an authorization to BCN, and BCN conducts a clinical review before making a decision.)

The following hospitals participate in the Metro Detroit EPO network:

  • Detroit Medical Center
    • DMC Children’s Hospital (Wayne County)
    • DMC Detroit Receiving (Wayne County)
    • DMC Harper–Hutzel (Wayne County)
    • DMC Huron Valley–Sinai (Oakland County)
    • DMC Sinai Grace (Wayne County)
    • DMC Rehabilitation Institute of Michigan (Wayne County)
  • Oakwood Healthcare, now part of Beaumont Health**
    • Oakwood Hospital and Medical Center, Dearborn (Wayne County)
    • Oakwood Hospital Southshore (Wayne County)
    • Oakwood Hospital Taylor (Wayne County)
    • Oakwood Hospital Wayne (Wayne County)
  • St. John Providence Health System
    • Providence Hospital (Oakland County)
    • Providence Park Hospital (Oakland County)
    • St. John Hospital and Medical Center (Wayne County)
    • St. John Macomb–Oakland Hospital Macomb Center (Macomb County)
    • St. John Macomb–Oakland Hospital Oakland Center  (Oakland County)
    • St. John River District Hospital (St. Clair County)
  • Saint Joseph Mercy Health System/CHE Trinity Health
    • St. Joseph Mercy Ann Arbor (Washtenaw County)
    • St. Joseph Mercy Chelsea (Washtenaw County)
    • St. Joseph Mercy Livingston (Livingston County)
    • St. Joseph Mercy Oakland (Oakland County)
    • St. Mary Mercy Hospital Livonia (Wayne County)
  • Botsford Hospital, now part of Beaumont Health** (Oakland County)
  • Garden City Hospital (Wayne County)
  • Stonecrest Center for Behavioral Health (Wayne County)
  • Straith Hospital for Special Surgery (Oakland County)

These hospitals participate in the Metro Detroit HMO network:

  • Botsford Hospital, now part of Beaumont Health** (Oakland)
  • Detroit Medical Center
    • DMC Children’s Hospital of Michigan (Wayne County)
    • DMC Detroit Receiving Hospital (Wayne County)
    • DMC Huron Valley–Sinai Hospital (Oakland County)
    • DMC Harper University/Hutzel Women’s Hospital (Wayne County)
    • DMC Sinai–Grace Hospital (Wayne County)
    • DMC Rehabilitation Institute of Michigan (Wayne County)
  • Oakwood Healthcare System
    • Oakwood Hospital Dearborn (Wayne County)
    • Oakwood Hospital Southshore (Wayne County)
    • Oakwood Hospital Taylor (Wayne County)
    • Oakwood Hospital Wayne (Wayne County)
  • St. John Providence Health/Ascension
    • Providence Hospital (Oakland County)
    • St. John Hospital and Medical Center (Wayne County)
    • St. John Macomb–Oakland Hospital, Macomb Center (Macomb County)
    • St. John Macomb–Oakland Hospital, Oakland Center (Oakland County)
    • St. John River District Hospital (St. Clair County)
  • Saint Joseph Mercy Health System
    • St. Joseph Mercy Ann Arbor (Washtenaw County)
    • St. Joseph Mercy Livingston (Livingston County)
    • St. Joseph Mercy Oakland (Oakland County)
    • St. Mary Mercy Livonia (Wayne County)

**Note: Beaumont Health campuses in Royal Oak, Troy and Grosse Pointe are not part of the EPO network.

Online tutorial
If you would like to learn more, please view our online tutorial located on web-DENIS. The tutorial will walk you through our Metro Detroit EPO and Metro Detroit HMO networks and individual plans. Here’s how you can find the tutorial:

  • Log in to Provider Secured Services.
  • Click on web-DENIS.
  • Click on BCBSM Provider Publications and Resources.
  • Click on Newsletters & Resources.
  • Scroll down to Blue Cross® Metro Detroit EPO and HMO local networks resources.
  • Click on Training presentation: Blue Cross® Metro Detroit EPO and HMO local networks.

Find a doctor
You can search for a participating doctor in the local networks using the Find a Doctor tool:

  • Go to bcbsm.com/find-a-doctor.
  • Click on Get Started.
  • Click on Advanced Search.
  • Select ZIP code, street address or city, state or county and type in the information.
  • Go to “Please select your plan.” In the drop-down menu, click on Individual and Family plans (under 65).
  • Go to “Please select your sub plan. In the drop-down menu, click on Blue Cross Metro Detroit (EPO) or Blue Cross Metro Detroit (HMO).
  • Choose the provider type.
  • Add additional search criteria (optional) or click Go.
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 2014 American Medical Association. All rights reserved.
Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and
independent licensees of the Blue Cross and Blue Shield Association.