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Exclusive Provider Organization (EPO) Plans
We offer individual Exclusive Provider Organization (EPO) plans to residents within the Birmingham Metropolitan Statistical Area (MSA) that includes Jefferson, Shelby, Walker, Chilton, Blount, Bibb and St. Clair counties.
Individual EPO plans use the Blue High Performance Network® (BlueHPN®), which is a limited provider network primarily restricted to the Birmingham MSA.
Use our EPO Quick Reference Guide for Providers for assistance in caring for patients with these plans.
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Effective January 1, 2025, the BlueHPN will only include specialists who use in-network facilities for services. This means that many specialists, including but not limited to those based at University of Alabama at Birmingham (UAB) Hospital, will no longer be in network. UAB’s planned acquisition of St. Vincent’s Health System is expected to result in renaming the Ascension St. Vincent’s facilities to “UAB St. Vincent’s.” Please note that St. Vincent’s hospitals and related physicians practicing at its facilities will remain in the BlueHPN. |
Important EPO Plan Requirements for Coverage
- The EPO plans only cover physicians and hospitals that have the BlueHPN designation, excluding accidental injury/medical emergencies. Note: Some hospitals in the Birmingham MSA are not designated as BlueHPN and are not covered by EPO plans.
- EPO plans require members to designate a primary care provider from the BlueHPN within the seven-county MSA prior to receiving medical coverage.
- An electronic referral from the patient’s designated PCP is required before services performed by other providers are covered. Review our How to Submit, Review and Cancel Referrals guide for more information.
- Providers should confirm their own status as a BlueHPN provider before accepting EPO plan patients. Also, they should verify that any necessary referrals have been obtained prior to rendering services.
How to Identify Providers and Hospitals in the BlueHPN
It’s important to check that a provider is in the BlueHPN to ensure coverage for your patients with EPO plans. You can see a description of in-network providers and facilities on our BlueHPN Providers webpage.
To check the BlueHPN status of a specific provider, use our Find a Doctor tool (see below) by selecting one of the following from the “All Networks/Plans” drop-down menu:
- Blue High Performance Network (BlueHPN): All providers and facilities in the BlueHPN.
- BlueHPN Primary Care Physician – EPO Plan: Providers who can be chosen as a primary care physician for the EPO plans that require members to designate a primary physician.
Note: This online directory lists providers at their practice location(s). Providers may be listed multiple times in the directory for each of their separate locations; however, their BlueHPN designation will display only for their locations within the seven-county MSA. Confirm the BlueHPN status by reviewing a provider’s specific location.
How to Identify Your Patients With EPO Plans
The Blue Saver Silver EPO or Blue Standardized Silver EPO name, along with the BlueHPN designation, appear on patients’ Blue Cross and Blue Shield of Alabama cards.
You can also identify members of this network by checking eligibility and benefits, as shown below.
Additional information is available on our BlueHPN webpage and our BlueHPN FAQs webpage.