There are two main types of plans offered by Blue Cross Blue Shield companies: HMOs and PPOs. There are actually a few other types, like EPOs and HSAs, but most customers opt for either an HMO or PPO plan. With an HMO (health maintenance organization) plan, the insured must choose a primary care physician (PCP), and all of the insured’s health care services under the policy are handled through the PCP. That means the insured must always get a referral from the PCP to receive further specialized services (except in an emergency). Additionally, HMO customers are limited to services available from in-network (those that have contracted with the HMO) providers. Pre-certification for most Blue Cross Blue Shield HMO drug rehab services is also required.
Individuals covered under a PPO (preferred provider organization) plan enjoy more flexibility in their treatment options compared to those with a HMO plan. PPO plans do not require choosing a PCP and, in most cases, customers are free to seek treatment from health care professionals, both in-network and out-of-network, without a referral (although a patient’s out-of-pocket costs are likely to be higher for out-of-network providers). So, the bottom line is that while all BCBS customers are covered for rehab services, those with a PPO plan will likely have a much broader range of treatment options to choose from than customers with an HMO plan.