Question: I live in San Diego, and have been leaning towards Blue Shield (PPO) versus Anthem (EPO) since I don’t like the idea of NO out of network coverage. However, my daughter will be going off to college at UC Santa Cruz in the Fall, and I notice that in Santa Cruz’s region, it is reversed, i.e. Blue Shield is an EPO whereas Anthem is a PPO. Does this have any unusual implications in my situation? My interpretation (assuming we have Blue Shield as a family) would be that in Santa Cruz, she would need to use a provider who was in-network for Blue Shield in Santa Cruz. Is this correct, or would she be able to transfer the “PPO-ness” of our San Diego Blue Shield policy up to school with her? I realized that this only matters if she really needs to see someone who is not in-network for Blue Shield up in that region. Is this an important enough reason to purchase her own policy vs. being part of the family ? And, in general, how will it work for ANYONE who travels to a different region (or out of state, for that matter) where the type of policy that your provider offers is different in the area that you are visiting ? I hope the question is clear, thanks for the service that you are providing.
Answer: The solution is for the family to buy the Blue Shield PPO because PPO members can access EPO providers, but EPO members are unable to access PPO providers. EPO members can only access other EPO providers in other counties. You are correct, no out-of-network coverage for EPO members except for emergencies. PPO members will have out-of-state coverage through BlueCard. EPO members will not.