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 see 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 see 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

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

Yes*

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

No

General Comments

* 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.

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

Yes*

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

Yes

General Comments

* 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.

Can I see 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. Always secondary to Medicare.

Can I see a Virginia Mason primary care provider if I have selected a non-Virginia Mason PersonalCare system?

No

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

Yes*

General Comments

* If the patient did not select the Virginia Mason PersonalCare Partner System 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.

* If Northwest Physicians Network (NPN) PersonalCare Partner System has been selected, 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 to be seen within Virginia Mason. Please note however that certain services may require prior-authorization by the payer.

Accepted Insurance Plans
  • Virginia Mason
  • Edmonds Family Medicine
  • Polyclinic
Can I see 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, Edmonds Family Medicine or Polyclinic, 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.

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

Yes

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

No

 

Insurance Definitions