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Blue Medicare HMO | Blue Medicare PPO | Healthy Blue + Medicare (D-SNP)

Medical management programs and services

Learn more about the programs and services Blue Medicare HMO and Blue Medicare PPO plans have implemented to maintain the high quality care for members.

Policies, guides and codes Responsibilities of primary care physicians (PCP)

Effective 1/1/2008, Blue Medicare HMO and Blue Medicare PPO members have the freedom to choose in-network providers and specialists without a referral. Members are still expected to select a primary care physician (PCP). Members are encouraged to visit their PCP before seeing a specialist. In this way, Blue Medicare HMO and Blue Medicare PPO PCPs are still able to coordinate generally for the overall care management for their patients.

  • Family practice/general practice doctors provide care for infants, children, adolescents and adults in the areas of community medicine, internal medicine, obstetrics and gynecology, pediatrics, psychiatry and surgery.
  • Internists (internal medicine) provide service for treatment of diseases in adults. Normally, they do not deliver babies, treat children or perform surgery.
  • Pediatricians typically treat children from birth up to the age of sixteen.
  • Geriatric doctors provide care for older adults.