Blue Review
A Provider Publication

November 2021

Blue Choice Opt PPOSM Network Expanding Throughout Illinois

We’re happy to announce that as of Jan. 1, 2022, the Blue Choice Opt PPO network, which includes Blue Choice OptionsSM and Blue OptionsSM plans will be available throughout the State of Illinois. If you’re currently contracted with Blue Cross and Blue Shield of Illinois (BCBSIL) for the Blue Choice Preferred PPOSM network,* as of Jan. 1, 2022, you’ll also be an in-network provider for members who access Tier 1 providers on the Blue Choice Options and Blue Options benefit plans.

Tiered products are designed to give the employer and the member the opportunity to help them self-manage their health care spending. With a tiered product, the member’s benefit level of cost-sharing is determined by the network tier according to the contracted provider that renders the service. Keep in mind that an employer can customize the benefit levels for each tier.

Here is the general, basic benefit structure of a tiered product:

  • Tier 1 is the highest benefit level and most cost-effective level for the member, as it is tied to a narrow network of designated contracted providers.
  • Tier 2 benefits offer members the option to select a provider from a broader network of contracted PPO providers, but at a higher out-of-pocket expense.
  • Tier 3 benefits, if offered, typically address the use of out-of-network providers as the highest cost option for covered services.

BCBSIL is committed to providing quality health insurance to all communities of Illinois. By expanding the Tier 1 service area for the Blue Choice Options and Blue Options benefit plans throughout Illinois, we are providing a lower-cost tiered PPO option to members in Illinois.

Remember, it’s important to check eligibility and benefits for each patient before every scheduled appointment. When doing so, look for Blue Choice Options or Blue Options on the BCBSIL members’ ID cards and verify eligibility and benefits through the Availity® Provider Portal or your preferred vendor portal. Eligibility and benefit quotes include important information about the patients’ benefits, such as membership verification, coverage status and applicable copayment, coinsurance and deductible amounts. The benefit quote may also include information regarding applicable prior authorization requirements. When services may not be covered, you should notify members that they may be billed directly.

Ask to see the member’s BCBSIL ID card for current information. Also ask for a driver’s license or other photo ID to help guard against medical identity theft. Remind your patients to call the number on their BCBSIL ID card if they have questions about their benefits. 

*Hospital Sisters Health System (HSHS) is excluded in the Springfield and the Metro East area of Illinois. Genesis Health System is excluded in the Illinois Quad Cities.

Checking eligibility and/or benefit information is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility and the terms of the member’s certificate of coverage applicable on the date services were rendered. If you have any questions, please call the number on the member’s ID card.

Information provided by BCBSIL is for informational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider, nor is the information presented intended to replace or supersede any requirements set forth in your contract with BCBSIL. Any samples in this communication are for illustrative and/or educational purposes only and should not be relied on in determining how a specific Provider will be reimbursed. In the event of a conflict between the information in this presentation and your contract, your contract will control.

Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSIL. BCBSIL makes no endorsement, representations or warranties regarding any products or services provided by third party vendors such as Availity.