Preferred providers are those who are in our Blue Shield PPO network. Non-preferred providers are not within our PPO network. When you go to a preferred provider, you save money and receive the highest level of benefits available.
Choice and Affiliate Providers
For members with our Blue Shield network choice program, there are two categories of providers within our PPO networks of hospitals and medical facilities: Choice and Affiliate.
You can save the most money by accessing Choice providers.
We created these two categories as a way of managing the rising cost of health care for everyone. Some hospitals and medical facilities are more expensive than others, making it necessary for us to ask our members to pay more when using these providers for several non-emergency services.
Find a Doctor will tell you whether a hospital is Choice or Affiliate. You should always check to see whether a hospital is Choice or Affiliate before you seek care.
Choosing a Non-Preferred Provider
This is a doctor, hospital or other medical professional that is not under contract with Blue Shield and not a designated member in the Blue Shield network.
If members choose a provider that is not in one of our networks, they may be responsible for additional payments above and beyond the Blue Shield allowed amount. Also, your copayments and deductibles may be higher, and your copayment maximum is often set at the highest level for your PPO plan.
You'll need to pay the non-preferred provider directly for the entire cost of your care, and then you must file a claim with Blue Shield within one year of the month you receive these services.
If submitting a claim applies to you, visit Help with Submitting a Claim.
If you still have questions, please call the Member Services number on your Blue Shield ID card.
-