For Providers: What Services are Covered by BCN Advantage HMO-POS for Out of State or Non-Contracted Providers?

BCN Advantage HMO-POS members who spend less than six consecutive months a year outside of Michigan are covered through a network of providers while traveling out of state. BCNA members can receive covered services from providers who participate with Blue Cross Blue Shield plans. These services must be preapproved.

If a member plans to be out of the service area for more than six months he or she must be disenrolled from BCN Advantage HMO-POS and re-enrolled under traditional Medicare.

Covered services and deductibles out of Michigan

Except for emergency services (including emergency dialysis), urgently needed care or services preapproved by BCN Advantage HMO-POS, unauthorized services may not be covered. Both Medicare and BCN Advantage HMO-POS may decline to pay for services that are not approved. Services obtained by BCN Advantage HMO-POS members who take advantage of benefits offered through our network of providers are subject to the following deductibles for out-of-state services:

  • $500 deductible for BCN Advantage HMO-POS Elements and Classic members
  • $200 deductible for BCN Advantage HMO-POS Prestige members
  • $280 for BCN Advantage HMO-POS Prime Value members living in Antrim, Benzie, Clinton, SsEmmet, Genesee, Grand Traverse, Isabella, Lake, Lapeer, Leelenau, Lenawee, Livingston, SsManistee, Mecosta, Midland, Missaukee, Osceola, Otsego, St. Clair and Wexford counties
  • $0 deductible for BCN Advantage HMO-POS Prime Value members living in other counties
  • $250 for BCN Advantage HMO-POS Community Value members

BCN Advantage HMO ConnectedCare members

BCN Advantage HMO ConnectedCare members do not have the out of state network of providers benefit. For these members, all services must be provided by the designated network of identified providers associated with the product, with the exception of medical emergencies (including emergency dialysis) and urgently needed care, which are covered worldwide. BCN Advantage HMO ConnectedCare does not offer a travel benefit for follow-up care for existing conditions.

More information

For more information about care for members outside of Michigan, see the “Care outside of Michigan” section of the BCN Advantage chapter (PDF) of the BCN Provider Manual.

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Related forms and documents

Non-Michigan providers: Referral and authorization requirements (PDF)
Waiver of Liability (PDF)
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