Finding a Preferred Provider
A preferred provider or "in-network" provider is a doctor, hospital, or other health care provider that participates in the Blue Cross Blue Shield Provider PPO network. Generally, you receive full coverage for most services from hospitals, physicians, and other providers in the Preferred Provider PPO network, although for some outpatient services, you may pay a $20 copayment for each visit. You pay a $150 copayment per visit for in-network or out-of-network emergency room services.
To locate participating providers in the BCBS Student Blue Plan Provider PPO network in Massachusetts or anywhere in the United States, go to gallagherkoster.com/Berklee, and select "Find a Doctor" in the menu on the left. Or visit Blue National Doctor and Hospital Finder to locate healthcare providers within the U.S., Puerto Rico, and U.S. Virgin Islands, or to find a doctor or hospital worldwide.
You can also obtain covered services from non-preferred or "out-of-network" providers, but your out-of-pocket costs will be higher. Also, you must pay a plan-year deductible for most out-of-network covered services.
You can go to any provider; however, you receive the highest level of benefits and save money by staying in-network and seeing providers who participate in the Blue Cross Blue Shield Blue Preferred Provider PPO network.
Note: If a preferred provider refers you to another provider for covered services (such as a lab or specialist), make sure the referred provider participates in the Blue Cross Blue Shield Blue Preferred Provider PPO network in order to receive benefits at the in-network level. If the provider you use is not a preferred provider, you're still covered, but your benefits will be covered at the out-of-network level, even if you were referred by a network provider.
For students who are new to the Boston area or who do not have an existing relationship with a doctor, Harvard Vanguard Medical Associates is a multi-specialty group practice offering more than 35 medical and surgical specialties. Conveniently located at 133 Brookline Avenue in Kenmore Square, Harvard Vanguard is a Preferred Provider in the BCBS Student Blue Plan. Their regular hours are Monday through Friday, 8:00 a.m. to 5:00 p.m.
Harvard Vanguard also offers urgent care hours for sudden illnesses "after hours" and during evenings and weekends. Urgent care hours are Monday through Friday, 5:00 p.m. to 8:00 p.m.; Saturday, 10:00 a.m.–5:00 p.m., and Sunday, 12:00 p.m.–5:00 p.m. You can reach Harvard Vanguard at 617 421-1000 or harvardvanguard.org.