The PPO is a cost containment benefit program that is made up of PPO hospitals and professional providers. PPO providers have agreed to fees set by BCBSIL as the maximum cost for their services. Written referrals are not required, but when a referral is necessary, the PPO provider must make every effort to refer the member to in-network PPO providers, hospitals, and laboratories. Referrals to out-of-network providers could result in reduced benefits for the member. Payment for services is according to the PPO Schedule of Maximum Allowances (SMA). Providers should bill BCBSIL prior to collecting any fees other than co-payments for the patient. After receiving the payment and Provider Claim Summary (PCS), providers may bill the member for any deductibles, coinsurance, or non-covered services. Providers may not balance bill the patient for any fees over the allowable charge.

Eligible Network Providers: 

• Certified Nurse Midwives
• Certified Nurse Practitioners
• Certified Registered Nurse Anesthetist (CRNA)
• Certified Surgical Assistants (CSAs)
• Certified Surgical Technologists (CSTs)
• Chiropractors
• Clinical Psychologist
• Durable Medical Equipment 
• Home Infusion
• Independent Lab
• Licensed Clinical Nurse Specialist
• Licensed Clinical Professional Counselors (LCPC)
• Licensed Clinical Social Worker (LCSW)
• Optometrists
• Orthotics
• Osteopaths
• Physicians
• Podiatrists
• Prosthetics 
• Registered Nurse First Assistants (RNFAs)
• Registered Surgical Assistants (RSAs)
• Sleep Medicine
• Surgical Assistants Certified (SACs)
• Therapist (Physical, Speech, Occupational)

Provider types not listed above may be eligible for a Blue Shield provider number. Please click the link below.

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