Preferred (BlueOption) Network
Frequently Asked Questions

1. What is the new network?
   The new network name is Preferred BlueOption. It joins our existing Utah networks— Preferred ValueCare and Participating (formerly known as Traditional).
   
   
2. When will the new network be available?
   The Preferred BlueOption Network became available for employer groups to select beginning January 1, 2010.
    
3. Why is Regence adding a new network?
   In 2010, we began transitioning employer groups from our standard health plan products (Traditional and ValueCare) to our self-managed and consumer directed health plan products (Regence Innova^®, Engage^®, Activate^SM, HSA Healthplan 2.0^SM and others as they are added). Employers can now choose which of the two Preferred networks will best meet the needs of their group for Category 1 benefit levels.
   
   
4. What is the advantage of two Category 1 choices?
   Having two Preferred networks allows Utah members to seek services from their choice of providers while taking advantage of the out‑of‑pocket savings associated with receiving services at Category 1 benefit levels. Over 93% of physicians or other health care professionals in Utah are included in Preferred networks. Additionally, all of the hospitals in the state participate in the Preferred BlueOption Network or the Preferred ValueCare Network; many participate in both Preferred networks.
   
   
5. Does the Preferred BlueOption Network replace the Preferred ValueCare Network?
   No. The Preferred BlueOption Network is in addition to the Preferred ValueCare Network. BlueOption is available to groups who purchase one of our self-managed and consumer directed products. The Preferred ValueCare Network continues to be available for members enrolled in the self-managed and consumer directed products, as well as members enrolled in our current ValueCare health plan product.

   Federal Employee Program (FEP) members continue to utilize the ValueCare Network as their Preferred network for physicians and other health care professionals, as well as for non-hospital facility services. All hospitals in the state are available to FEP members at their highest benefit level.

   BlueCard (PDF) members with a “PPO in the suitcase” icon on their member card continue to utilize providers and hospitals in the ValueCare Network for their highest benefit. BlueCard members with a blank suitcase may receive services from any Participating provider or hospital in the state.
   

6. What hospitals are included in each Preferred network?
   All Utah hospitals are included in one or both Preferred networks. The charts below illustrate the Preferred network(s) with which each hospital participates.
   
   

   Preferred BlueOption Network Hospitals
   Allen Memorial Hospital	Fillmore Hospital	Orem Community Hospital
   Alta View Hospital	Garfield Memorial Hospital	Park City Medical Center
   American Fork Hospital	Gunnison Valley Hospital	Primary Children’s Medical Center
   Ashley Regional Medical Center	Heber Valley Medical Center	Riverton Hospital
   Bear River Valley Hospital	Intermountain Medical Center	San Juan County Hospital
   Beaver Valley Hospital	Kane County Hospital	Sanpete Valley Hospital
   Castleview Hospital	LDS Hospital	Sevier Valley Medical Center
   Central Valley Medical Center	Logan Regional Hospital	The Orthopedic Specialty Hospital
   Davis Hospital and Medical Center	McKay-Dee Hospital	Uintah Basin Medical Center
   Delta Community Medical Center	Milford Valley Hospital	Utah Valley Regional Medical Center
   Dixie Regional Medical Center	Mountain West Medical Center	Valley View Medical Center

   
   

   Preferred ValueCare Network Hospitals
   Allen Memorial Hospital	Gunnison Valley Hospital	Primary Children’s Medical Center
   Ashley Regional Medical Center	Heber Valley Medical Center	Salt Lake Regional Medical Center
   Bear River Valley Hospital	Huntsman Cancer Hospital	San Juan County Hospital
   Beaver Valley Hospital	Jordan Valley Medical Center	Sanpete Valley Hospital
   Brigham City Hospital	Kane County Hospital	Sevier Valley Medical Center
   Cache Valley Specialty Hospital	Lakeview Hospital	St. Marks Hospital
   Castleview Hospital	Logan Regional Hospital	The Orthopedic Specialty Hospital
   Central Valley Medical Center	Milford Valley Hospital	Timpanogos Regional Hospital
   Davis Hospital and Medical Center	Mountain View Hospital	Uintah Basin Medical Center
   Delta Community Medical Center	Mountain West Medical Center	University Hospital
   Dixie Regional Medical Center	Ogden Regional Medical Center	University of Utah Orthopedic Center
   Fillmore Hospital	Park City Medical Center	Valley View Medical Center
   Garfield Memorial Hospital	Pioneer Valley Hospital

   
   
7. How will members and providers know whether the selected Preferred network is the ValueCare or BlueOption Network?
   The Preferred network designated to provide access to Category 1 benefit levels will be displayed on the member card above the health plan product name.
   Note: The product name will not be displayed if the member’s group has purchased a customized version of one of these products.
   
   
   
   
8. If a group chooses BlueOption as its Preferred Provider Network choice, do the benefits change?
   No. Benefits will remain the same for Innova, Engage, Activate and HSA Healthplan 2.0 health plan products.
   
   
9. How will this affect BlueCard and FEP members?
   The Preferred BlueOption Network does not apply to the BlueCard Program or to the Federal Employee Program (FEP).

   BlueCard members with a “PPO in the suitcase” icon on their member card continue to utilize providers and hospitals in the ValueCare Network for their highest benefit. BlueCard members with a blank suitcase may receive services from any Participating provider or hospital in the state.  

   FEP members continue to utilize the ValueCare Network as their Preferred network for physicians and other health care professionals, as well as for non-hospital facility services. All hospitals in the state are available to FEP members at their highest benefit level.
   
   
10. Does this impact Regence MedAdvantage members?
    No. Regence MedAdvantage members continue to access the Regence MedAdvantage Network of providers.
    
    
11. What should a provider’s office staff be aware of?
    
    

    •	Offices can identify members on these products by the colorful background designs on their member cards. Designs include the member’s choice of: a snowboarder image, one of four cityscapes (Boise, Portland, Salt Lake City or Seattle) or one of two graphic designs (diamonds or circles). Typically, one of the following health plan product names will be displayed on the member card: Innova, Engage, Activate or HSA Healthplan 2.0. The Preferred BlueOption network is not available on any other health plan product. Note:  The product name will not be displayed if the member’s group has purchased a customized version of one of these products.
    •	The Preferred network selected to provide access to Category 1 benefit levels (BlueOption or ValueCare) will be displayed on the member card above the health plan product name (except in the case of custom products as noted above).
    •	Office visit copayment amounts and the number of up-front visits will be included on the member card, if applicable.

    
    
12. What if a member is in her last trimester of a pregnancy when her employer group changes its choice of Preferred networks to the Preferred BlueOption Network, and the member’s doctor will not deliver at one of the BlueOption Network hospitals?
    Hospital affiliation is a personal consideration each provider must make. Members may receive services at any hospital; however, if the provider does not practice at a hospital in the member’s Preferred provider network, members will not receive Category 1 benefit levels under their health plan. The member will need to choose whether to retain her current physician and received benefits for the services at a Category 2 or Category 3 level, or select a provider who does practice at a hospital in the member’s Preferred Provider Network. We are asking providers to advise members of their affiliated hospital’s network, but it is primarily the member’s responsibility to be aware of his or her benefits and network options.

View hospitals in the Preferred BlueOption Network
View hospitals in the Preferred ValueCare Network

13. What about continuation of care considerations? What if a member is in the hospital at the time of the network change (i.e., member is admitted to a Preferred network hospital on December 28, with care continuing past January 1, but the employer has selected a different Preferred network effective January 1)?
    Because of the change in designated Preferred network, the hospital claim must be split – one claim for dates of service prior to January 1 and another claim for dates of service beginning January 1. The claim for services received prior to January 1 will be processed at the Category 1 benefit level; the claim for services received on January 1 through discharge will be processed at the Category 2 or Category 3 benefit level.
    
    
14. Will physicians or other health care professionals (professional providers) need to sign a BlueOption addendum?
    The current Preferred addendum applies to both Preferred networks so, generally, no additional contracting is needed for professional providers. Our Network Development team has identified and will be contacting those professional providers that will need to sign a new addendum.
    
    
15. How will benefits be administered if a Preferred professional provider sends lab work to the hospital they are affiliated with, but the hospital is not in the patient’s selected Preferred network?
    Services rendered and billed by the Preferred provider will be paid at the Category 1 benefit level, but any lab services which that provider sends to a facility not participating in the patient’s selected Preferred network will be paid at the Category 2 or Category 3 benefit level. Any other services billed by the facility, such as radiology or pharmacy will also be processed at Category 2 or Category 3 benefit levels. This will result in the patient paying higher out-of-pocket costs. We urge providers in this situation to be aware of what facilities are available for Category 1 benefit levels for these adjunct services.

16. Where can we find additional information?
    Learn more about the Preferred BlueOption Network—including links to the updated Regence Innova, Engage, Activate and HSA Healthplan 2.0 online workshop and affected Administrative Manual sections.
    
    
17. Who should we contact if we have additional questions about the Preferred BlueOption Network?
    Contact Provider Customer Service for Innova, Engage, Activate and HSA Healthplan 2.0 products at 1 (877) 417‑6222 or you may contact your provider consultant.