Premera Blue Cross

Information regarding accepted Premera Blue Cross insurance plans.

Insurance Definitions

Premera Blue Cross Plan Names

Can I choose or visit a Virginia Mason primary care provider (PCP) under this insurance plan?

If I need to see a specialist or have a specialty service, does this insurance plan require pre-approved referral authorization?

(Applicable to Urgent Care Locations as Well)

General Comments

* Please review comments if an asterisk is present.

* Blue Cross/Blue Shield (BC/BS) Out-of-State

Yes

No

* The assigned alpha prefix identifies whether the services are billed under BC/BS.

Premera PersonalCare Partner System – Virginia Mason

  • Virginia Mason or
  • Edmonds Family Medicine

Yes

 

* No

 

* Patients covered under this program must receive services from primary care providers through Virginia Mason or Edmonds Family Medicine, and specialty providers through any of the participating organizations listed under Puget Sound High Value Network (PSHVN) unless services are for an emergency. Approved referrals are not required for care received within the network.

 
If a patient covered under this plan is in need of a service that is not available through these participating organizations, they may also be referred to the Premera Heritage Signature/Heritage Prime network of providers.  An approved referral is required if they are receiving services outside of their selected PersonalCare System and within the Premera Heritage Signature/Heritage Prime network.  If patient receives care out-of-network, patient will have no benefits – claims will be denied. 

 

Premera PersonalCare Partner System

  • Non-Virginia Mason or Edmonds Family Medicine PCP

No 

* Yes

 

* If patient did not select the Virginia Mason PersonalCare Partner System and choose a Virginia Mason or Edmonds Family Medicine PCP and receives care within Virginia Mason without a referral waiver from their selected PersonalCare Partner System, the patient will be considered as out-of-network and services will not be covered. Patient would have full financial responsibility for serviced denied as out-of-network 

Traditional Indemnity

Yes

No

 

* Premera Preferred (Exchange program) – ID card indicates Heritage Signature

  • Bronze
  • Silver
  • Gold

Yes

No

* Heritage Premier will be on the ID card.

* Premera Medicare Supplement

Yes

No

* This is a Medigap plan. Always secondary to Medicare.

All Dimensions Plans

Yes

No

* Including Heritage Networks

Medicare Advantage Programs:

* Premera Medicare HMO

* Yes

Yes

  • * Effective February 1, 2015, Virginia Mason is contracted.
  • If patient does not have a Virginia Mason PCP, under HMO, an approved referral is required for specialty care. Unless the patient is electing to utilize their POS benefits, if available.

* Premera Medicare Advantage Plus HMO/POS

* Yes

No

Contact your health insurance plan for information on covered services before your appointment.