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Miami-Dade Blue


Plans

Miami-Dade Blue, is a PPO product designed to offer a benefit plan primarily for low-income working and non-working uninsured residents of Miami-Dade County. The plan includes individual and group coverage.

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Provider Networks

The provider network for our Miami-Dade Blue plans is the Miami-Dade Blue Network.  Miami-Dade Blue members may seek care from providers in their network (Miami-Dade Blue), Traditional/PPS/PHS network providers or other non-network providers.  Florida Blue will make the payment directly to the provider for covered services.  

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Miami-Dade Blue Providers

Providers participating in Miami-Dade Blue network(s) are reimbursed based on the terms of their Agreement for services to Miami-Dade Blue members and have agreed to accept the Florida Blue allowed amount as payment-in-full for covered services. Florida Blue will pay the allowed amount less the member deductible, coinsurance, and/or copayment as payment in full for covered services. When members access Miami-Dade Blue providers, covered benefits are reimbursed at a higher benefit level, and their out-of-pocket costs are usually much lower.

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Traditional/PPS/PHS Providers

Miami-Dade Blue members also have access to the Traditional/PPS/PHS network.  When members access Traditional/PPS/PHS providers, covered benefits are usually reimbursed at a lower non-participating level and their coinsurance percentage and/or copayment is higher.  As a participating Traditional/PPS/PHS network provider, you may not balance bill the member. 

 

1/13/2014
The Manual is not intended to be a complete statement of all BCBSF polices or procedures for providers. Other policies and procedures, not included in this Manual, may be posted on our website or published in special publications, including but not limited to, letters, bulletins, or newsletters. Any section of this Manual may be updated at any time. In the event of any inconsistency between information contained in this Manual and the agreement(s) between you or your facility and BCBSF or Health Options the terms of such agreement(s) shall govern.

The Manual is not intended to be a complete statement of all Florida Blue polices or procedures for providers. Other policies and procedures, not included in this Manual, may be posted on our website or published in special publications, including but not limited to, letters, bulletins, or newsletters. Any section of this Manual may be updated at any time. In the event of any inconsistency between information contained in this Manual and the agreement(s) between you or your facility and Florida Blue or Health Options the terms of such agreement(s) shall govern.

Refer to the References section to view all applicable copyrights, registered trademarks, service marks, and/or references. Acronyms are also defined in the References section.

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© 2012 Florida Blue is a trade name of Blue Cross and Blue Shield of Florida Inc., an Independent Licensee of the Blue Cross and Blue Shield Association.