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 BlueMedicare PPO

BlueMedicare Individual PPO Front
BlueMedicare Individual PPO Back

Products and Plans
 
Alpha Prefix: XJP
In-Network: Medicare Advantage PPO/Medicare Advantage PPO Network Sharing (out-of-state)
Out-of-Network: Providers that do not accept assignment on Medicare claims cannot bill the member more than 15 percent over the allowed amount, unless the provider has completely opted-out of the Medicare program.
Additional Information: Service area consists of Alachua, Broward, Charlotte, Collier, Escambia, Hernando, Highlands, Hillsborough, Lee, Manatee, Marion, Okaloosa, Osceola, Palm Beach, Pasco, Pinellas, Polk and Sarasota counties.
Benefit
 
Availity: This is a copay and deductible based plan. Access Availity for member specific details.
Utilization Management
 
Utilization Management: Care for this member may require coordination with BCBSF or other entities. Refer to the Utilization Management section for details.
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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