Find more information about how we choose the doctors, hospitals and health care professionals for our HMO networks here.
Blue Care Network has a variety of HMO networks in Michigan. Our Blue Cross Preferred network covers the entire state. Our other HMO networks, including Blue Cross Select and Metro Detroit HMO are available in select counties. These networks are subsets of the Blue Cross Preferred network and are often referred to as value networks. They offer additional cost savings while maintaining quality of care. All our HMO networks are available in bronze, silver and gold tier plans.
Select an HMO network to learn more about how we select physicians, hospitals and other providers.
Doctors and hospitals in our Blue Cross Preferred network have to meet strict standards:
The Blue Cross Select network gives members a lower-cost option. This network has primary care physicians, or PCPs, in 20 counties who meet minimum standards for cost and quality measures.
Members who live in these counties can choose this plan:
Doctors and hospitals in the Blue Cross Select network are also part of our statewide Preferred network. Blue Cross Select providers must meet additional requirements to take part in this value network.
Blue Cross Select providers meet quality standards set by the National Committee for Quality Assurance and the National Quality Forum. These standards include quality scores based on Healthcare Effectiveness Data and Information Set (HEDIS) measures, such as offering immunizations and cancer screenings.
After we make sure that providers meet these quality standards we look at the total cost of care for their patients. This includes physician, hospital and pharmacy costs for members. We then include only providers with the lowest costs, which is about the top 70 percent.
The Metro Detroit HMO network gives members in the Detroit area a lower cost health plan option with excellent geographic coverage. This is based on significant savings from working with a select group of physicians and hospitals.
Members who live in Wayne, Oakland and Macomb counties can choose this plan. All Metro Detroit HMO network providers are also located in these counties.
Doctors and hospitals in the Metro Detroit HMO network are also part of our statewide Preferred network. Metro Detroit HMO providers must meet additional requirements to take part in this value network.
Physician organizations that are part of the Metro Detroit HMO network commit to:
Participating physician organizations then pick primary care physicians from their organization based on this commitment to cost, quality of care and location.
The choice of specialist physicians is based on the long-standing referral patterns of primary care physicians in the physician organizations. These referral patterns are based on factors specific to specialists, including but not limited to:
Hospitals in the Metro Detroit HMO network were selected because they agreed to lower their rates on certain Blue Cross products and work with the selected physician organizations.
Ancillary providers are selected by the physician organization, participating health systems and Blue Care Network. Ancillary providers include ambulatory surgery, physical therapy, home health and optometry. If these providers are part of a health system not listed in this plan’s network, they may be excluded from the plan.
Members who have this plan can see Blue Care Network providers outside the Metro Detroit HMO network with a referral from their primary care physician. Some services may also require authorization from Blue Care Network.
Hospitals in the Metro Detroit HMO include:
Our Blue Cross Partnered network has primary care physicians, specialists and hospitals in West Michigan that are part of Mercy Health System. Providers in this network agree to deliver care at specific costs, which lowers costs for members.
Members who live in Kent, Muskegon and Oceana counties can choose the Blue Cross Partnered plan.
Doctors and hospitals in the Blue Cross Partnered network are also part of our statewide Preferred network. Blue Cross Partnered providers must meet additional requirements to take part in this value network.
Ancillary providers selected by the Mercy Health System and Blue Care Network include ambulatory surgery, physical therapy, home health, optometry, etc.
If a member gets care from a Blue Care Network provider that is outside of the Blue Cross Partnered network, they’ll need to get authorization from their primary care physician and Blue Care Network.
In addition to the specific criteria that providers must meet to belong to our networks, we monitor other factors. Read how we make sure members have sufficient access to care and the types of providers in our networks.
We make sure that members have access to care within a reasonable distance to their home. We use standards that include travel time or distance.
We regularly monitor access to primary care providers, specialists, ancillary providers and facilities. If necessary, additional providers that meet our credentialing and network requirements may be added. This is how we make sure members have proper access to care.
At least 90 percent of our member population has to have access to a certain number of providers within a certain travel time or distance from their home, no matter where they live. The standard varies by specialty and type of area. For example, in a large metro area, members must have at least one primary care provider within 10 minutes or five miles from their home. In a rural area, the access standard for primary care providers is 40 minutes or 30 miles.
Read about our access standards (PDF) for primary care providers, specialists and hospitals in each area type.
Ancillary and Allied Providers and Facilities
Privacy issues: To report a concern or if you think your protected health information has been compromised, please call us at 1-800-552-8278 or email us. Don't include any protected health information in your email.
Other issues: For customer service, call the number on the back of your member ID card.