Under the PPO, physician referrals are not required.  PPO members will decide for themselves when to visit a specialist -- without a referral from their primary care provider.

PPO Network:  You will have “in-network” access to the Blue Cross and Blue Shield of North Carolina “Blue Options” PPO network that includes:

• 90% of the Primary Care Physicians in the State
• 85% of the Specialists in the State
• 97% of Hospitals in the State

The list of in-network providers is subject to change.  You should verify that your provider is still a part of the network before you start to receive services.

The link to the right will take you to the PPO provider search.  Once on the page, under "Find A Doctor (PPO Plans)" located at the top of the page, you may locate a provider inside or outside of North Carolina.

Out-of-Network Providers:  Under any of the three PPO options, you will be eligible to obtain medical services from “out-of-network” providers (i.e., physicians, hospitals or other providers not in the Blue Options PPO network).  However, out-of-pocket employee costs for co-pays, co-insurance and deductibles will be significantly higher than in-network costs.

Out-of-State:  If you live or travel outside of North Carolina, you can receive care from participating Blue Cross and Blue Shield providers at the same in-network benefit level.  The member is responsible for pre-authorization of services received outside North Carolina.  Click on the link to the right for a list of providers.

Out-of-Country:  If you receive services outside the U.S. from a participating facility most providers will file the claim for you.  Otherwise, you will need to pay for the services rendered and file the claim with Blue Cross and Blue Shield to receive reimbursement.