• How does the PPO Plan work?
• What is a PPO Primary Provider (PPP)?
• What services are covered under the PPP office visit copayment?
• How does my prescription drug plan work?
• What if I have questions about my benefits?
This is a Preferred Provider Organization (PPO) plan that lets you see the providers you want to see. You do not have to choose a primary care provider and do not need a referral to see a specialist. Providers are classified as "Preferred" (in-network) or "Nonpreferred" (out-of-network), and your choice of provider will determine the amount of your out-of-pocket costs. You will pay a higher deductible and higher out-of-pocket costs if you visit Nonpreferred Providers, but it is your choice to receive most covered health care services from any licensed provider. For most services, you will have a deductible to meet and will then be responsible for paying coinsurance (a percentage of covered charges).
What is a PPO Primary Provider (PPP)?
A PPO Primary Provider (PPP) is a Preferred Provider in one of the following medical specialties: Family Practice, General Practice, Internal Medicine, Obstetrics/Gynecology, Gynecology, or Pediatrics. PPPs do not include physicians specializing in any other fields such as Obstetrics only, Geriatrics, Pediatric Surgery, or Pediatric Allergy. When you see a PPP for an office visit, you pay a copayment. To find a PPP, search the Provider Finder®. You may also call Customer Service at the number on the back of your BCBSNM member ID card for help looking for a PPP.
What services are covered under the PPP office visit copayment?
The PPP office visit copayment covers only the PPP's office visit charge. You will pay deductible and coinsurance for other related services you receive during the visit.
How does my prescription drug plan work?
For information about your prescription drug plan, see Prescription Drug Benefits.
What if I have questions about my benefits?
BCBSNM's customer service representatives are available to answer your questions 6 a.m. to 8 p.m. MT, Monday through Friday, and 8 a.m. to 5 p.m. MT on weekends and holidays (closed Thanksgiving and Christmas Day). If you call after hours, you can leave a message and we will return your call by the next business day. Call the toll-free number printed on the back of your member ID card. Please have your ID card available when you call. You may also e-mail your questions to BCBSNM Customer Service.
Learn More About Western Refining PPO Plan:
PPO Plan Overview
Benefit Information
Prescription Drugs
Dental Care
Provider Information
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