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Specialty care for Medicare Plus Blue PPO^SM

Medicare Plus Blue PPO allows all members direct access to health specialists for in-network routine, preventive and specialty services. For most services, individual members will have higher copayments when they see specialists rather than general care physicians such as general practice, family practice, internal medicine, obstetrics and gynecology, pediatrics, nurse practitioners and physician's assistants.

The higher in-network copayment for specialty services may apply to Medicare Plus Blue Group PPO^SM members.

BCBSM encourages Medicare Advantage PPO practitioners (or their office staff) to assist members whenever possible in finding an in-network practitioner who can provide necessary services. If assistance is needed in arranging for specialty care (in- or out-of-network), please call our Provider Inquiry department at 1-866-309-1719.

Refer to Medicare Plus Blue PPO member and group benefit summaries for more information.

Plan basics

• Medicare Plus Blue PPO manual (PDF)
• MA PPO contract documents
• Medicare Advantage library

Coverage details

• Benefit summaries
• Enhanced benefits
• DME coverage
• Medicare Advantage PPO lab network
• Specialty care
• Drugs, drug plans and vaccines

Billing & payment

• Eligibility and coverage
• Billing members
• Submitting claims
• Overpayment
• Reimbursement
• Claims questions and appeals
• If you don't participate with Medicare

Evaluation and management

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• Hospice care

Overview & resources

• Other Blue plans (PDF)
• Contact information
• ID card
• FAQs
• CMS Quality Star Ratings program
• Health e-Blue^SM
• Healthy Advantage Rewards
• Fraud, waste and abuse training
• Medicare guidelines
• Medicare resources
• Types of products
• Glossary
• Site map

Evaluation and management

• Hospice care

Care management

• Prior notification and utilization management
• Care management