What is BlueCard PPO?
BlueCard PPO (Preferred Provider Organization) is a network of 35 independent, locally operated Blue Cross Blue Shield plans. Although these regional plans operate independently of one another, they are connected through the BlueCard PPO network, which allows them to act similarly to a national network.
Currently, Empire BCBS of New York is the only BlueCross BlueShield plan Alma is in network with. This means that you must be located in New York state to use your BlueCross BlueShield benefits through Alma, even if your plan is part of BlueCard PPO.
Home Plan: The regional BCBS entity that you have insurance through. This is determined by where your insurance was purchased, and may not necessarily be the region you live in.
For example, let’s say you have insurance through your employer who is headquartered in Texas. If your employer purchases insurance for its employees through BlueCross BlueShield of Texas, then BCBS of Texas would be your home plan, regardless of whether or not you live in Texas.
Host Plan: The regional BCBS entity that operates in the state or county where care is being accessed, if it’s being accessed outside of the home plan service area. This does not need to be your permanent address or state of residency.
Using the example above, if your home plan is BCBS of Texas, but you live in Illinois, you would access care through BCBS of Illinois. In this case, BCBS of Illinois would be your host plan.
Host State: Refers to the state in which you are accessing care, and doesn’t need to be your permanent address or state of residency. If BCBS of Illinois is your host plan, then Illinois would be considered your host state.
BCBS Association or The Association: This is the entity that sets policies and procedures for the BlueCard PPO network. The processes set by the Association are consistent across all BlueCard participating plans.
How can I tell if my BCBS plan is part of the BlueCard PPO network?
If your plan is part of BlueCard PPO, your member ID card will always include both of the following:
- A 3-4 character alpha-numeric prefix as part of the member ID, and
- A suitcase logo
If your member ID card does not have both the alpha-numeric prefix and the suitcase logo, your health plan is not part of BlueCard PPO. Please keep in mind that the design of the suitcase icon may appear differently on a member ID card depending on the type of plan.
Below are two examples of Blues PPO member ID cards accepted as part of Alma’s partnership with BlueCard PPO.
BlueCard PPO or EPO Member ID
Photo via Regence Blue Shield
BlueCard PPO Basic Member ID
Photo via BCBS of MA
Please note: Alma is not considered in network with Traditional, POS, or HMO plans, “High-Performance” Network for EPO plans, or with plans administered through Medicaid or Medicare, and therefore cannot accept Member ID cards with HPN or MA in the suitcase icon, or an empty suitcase icon.
If you still have questions about BlueCard PPO coverage and whether or not your plan is part of the BlueCard PPO network, please call the number on the back of your insurance card.
Finding a Provider
There are a couple of important factors to keep in mind when looking for an Alma provider through a BlueCross BlueShield plan or through BlueCard PPO.
The provider you work with must:
- Be licensed in the state where you are accessing care
- Be in network with the BlueCross BlueShield plan in the state where you are accessing care*
Note: When searching for a provider, you can see where the provider is licensed and what insurance companies they’re in network with in their Alma profile.
In addition to the provider requirements, you must:
- Be located in a state where Alma is partnered with a BCBS plan*
- Have either:
2a. A BCBS plan that Alma partners with*
2b. Another regional BCBS plan with BlueCard PPO coverage
*At this time, Alma is only partnered with Empire BCBS of New York. This means that you must be located in New York state to use your BlueCross BlueShield benefits through Alma, even if your plan is part of BlueCard PPO. See Insurances Partnered with Alma for a list of plans Alma is currently partnered with.
You live in New York and have insurance through Empire BCBS. Alma is in network with Empire BCBS and therefore, you are eligible to see any of Alma’s providers who are licensed in New York and accept Empire BCBS.
You are employed by a company headquartered in Massachusetts, so your coverage is through BCBS of Massachusetts.
However, you live in New York and have BlueCard PPO Coverage.
Since Alma is in network with one of New York’s regional BCBS plans, Empire BCBS, you are eligible to see any of Alma’s providers who are licensed in New York and credentialed with Empire BCBS.
Using Alma’s Search Function to Find a Provider
To search for a provider in network with your BCBS plan, head to Alma’s Find a Provider page:
- What type of service? Input the type of service you’re looking for (individual, couples, or family therapy, medication management, etc.)
- Which Insurance? Select the BCBS plan that corresponds with the state or region you’re seeking therapy in.
- If you’re not sure what plan to choose, please call the number on the back of your insurance card. Let them know where you’ll be accessing mental health care from and they should be able to tell you which BCBS entity operates in that region.
- If you’re having trouble getting this information from your insurance company, please reach out to firstname.lastname@example.org with your name, the location you’re seeking therapy from, and a copy of the front and back of your insurance ID card.
- Your city or ZIP. Enter the location where you’ll be seeking therapy.
- Virtual or in-person? Choose between virtual or in-person therapy, or a mix of both.
- Click Explore Providers to see a list of providers who accept your insurance in your area.
Selecting your BCBS Plan
Once you’ve found a provider and met with them for a consultation (see What to Expect After You Request a Consultation), you’ll receive an email from Alma with a link to enter your insurance information into the Alma portal. Please have your insurance card with you when entering this information!
From the Insurance Company dropdown menu, select your BCBS home plan (this will be the name of the BCBS entity on your insurance card).
Please note that you’ll only have the option to select a BlueCross BlueShield plan if your provider is contracted with BlueCross BlueShield.
You’ll also be asked to upload a picture of the front and back of your insurance card. This allows our team to confirm your eligibility by verifying that your coverage is active and your insurance benefits cover the services the therapist will provide. The eligibility check also confirms how much the insurance company estimates your service will cost (your payment responsibility).
Your payment responsibility is determined by either your home plan or your host plan and depends on whether you owe a copay or coinsurance. Copays are set by your home plan, whereas coinsurance will be based on your host plan’s rates.
For more information about eligibility, copays, and coinsurance, check out our Support Center guide to Understanding your in-network coverage.