Using Your HMO Option
Your primary care physician will arrange for your admission to a hospital when you need inpatient hospital care.
If you need surgery or other hospital treatment on an outpatient basis, your primary care physician will make those arrangements for you as well.
Using Your PPO Option
Your physician will help you obtain approval for hospitalization and will arrange for your admission to the hospital when you need inpatient care.
If you receive inpatient services from a non-preferred (non-network) hospital, you will be responsible for your copayment for hospital services, and you will also be responsible for all charges above the allowed amount.
View your medical benefits for specific information about these copayments or see your Evidence of Coverage.
Your PPO Option for Inpatient Services Outside of California
If you need hospitalization when you are outside of California and beyond the United States, your inpatient hospital service benefits are the same when you go to a BlueCard network hospital as they are when you go to a preferred hospital in California. (Learn more about preferred providers.)
The BlueCard hospital will contact us to confirm your coverage and will bill Blue Shield of California for your covered inpatient hospital services. All you'll need to pay for covered hospital services are the hospital copayments and deductibles. View your medical benefits for details about your copayments and deductibles.
However, inpatient physician services, such as physician visits, surgery and anesthesia administration are usually billed separately from inpatient hospital services.
You must pay for all other physician services you receive at hospitals outside of the United States at the time you receive those services, and then submit a claim within one year of the month you receive those services to:
Blue Shield of California's Foreign Claims Department
P.O. Box 272550
Chico, CA, 95927-2550
We will notify you of our coverage decision within 30 days of receiving that claim. If you have any questions about foreign claims, including what information they should contain, contact us.
Whenever you receive care overseas, you should notify your primary physician when you return home, so he or she can provide any necessary follow-up care.
Outpatient Surgery Under Your PPO Option
There are ambulatory surgery centers within our preferred provider network that can save you money when you need outpatient surgery.
For the PPO option of your POS plan, there may be lower copayments for having outpatient surgery in a preferred (network) ambulatory surgery center versus a hospital facility. To see the cost differences, refer to your Evidence of Coverage. To help lower your healthcare costs, you may want to discuss ambulatory surgery centers with your physician when you need outpatient surgery.
Here are three ways you can locate a preferred ambulatory surgery center:
- Use Find a doctor and search for an ambulatory surgery center.
- Check your printed copy of our Provider Directory.
- Contact us.