Premera Blue Cross

Information regarding accepted Premera Blue Cross insurance plans. Click on a plan to learn more.

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

Premera Blue Cross Insurance Plans

Blue Cross/Blue Shield (BC/BS) Out-of-State
Can I select a Virginia Mason primary care provider with this insurance plan?

Yes

Does this plan require pre-approval to see a specialist?

No

General Comments

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

Can I select a Virginia Mason primary care provider with this insurance plan?

Yes*

Does this plan require pre-approval to see a specialist?

No*

General Comments

* Including Heritage Networks and Lifewise

Can I select a Virginia Mason primary care provider with this insurance plan?

Yes*

Does this plan require pre-approval to see a specialist?

Yes*

General Comments

* If patient does not have a Virginia Mason PCP, an approved referral is required for specialty care.

Can I select a Virginia Mason primary care provider with this insurance plan?

Yes

Does this plan require pre-approval to see a specialist?

No

General Comments

This is a Medigap plan, not the BC/BS Medicare Advantage program. Always secondary to Medicare.

Does this plan require pre-approval to see a specialist if I am not with the Virginia Mason PersonalCare Partner System?

Yes*

General Comments

* If patient did not select the Virginia Mason PersonalCare Partner System and choose a Virginia Mason, Polyclinic 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.

Accepted Insurance Plans
  • Virginia Mason
  • Polyclinic
Can I select a Virginia Mason primary care provider if I have selected the Virginia Mason PersonalCare Partner system?

Yes

Does this plan require pre-approval to see a specialist?

No*

General Comments

* Patients covered under this program must receive services from primary care providers through Virginia Mason or Polyclinic (if after Jan.1, 2018), and specialty providers through participating organizations, 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 participating organizations, they may also be referred to the Premera Heritage Signature network of providers.

Accepted Insurance Plans
  • Northwest Physicians Network (NPN) — their ACO network
Can I select a Virginia Mason primary care provider if I have selected the Virginia Mason PersonalCare Partner system?

No

Does this plan require pre-approval to see a specialist?

No*

General Comments

Virginia Mason is a participant in the NPN ACO network. As Virginia Mason is considered in network for the NPN ACO, patients in the NPN ACO network via the Premera PersonalCare Partner program are not required to have insurance approved referrals.

Accepted Insurance Plans
  • Bronze
  • Silver
  • Gold
Can I select a Virginia Mason primary care provider with this insurance plan?

Yes

Does this plan require pre-approval to see a specialist?

No

General Comments

Heritage Premier will be on the ID card.

Can I select a Virginia Mason primary care provider with this insurance plan?

Yes

Does this plan require pre-approval to see a specialist?

No

Can I select a Virginia Mason primary care provider with this insurance plan?

Yes*

Does this plan require pre-approval to see a specialist?

No

 

Insurance Definitions