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BlueCross BlueShield Nebraska
BlueCross BlueShield Nebraska

Direct Primary Care

The Direct Primary Care (DPC) plan has no copays, deductibles or coinsurance for DPC services, as long as you use your CHI Health DPC provider. If you see a non DPC, you receive no coverage for these services and will pay the full billed charges. The average DPC panel size is approximately 900 patients (2300 for primary care). With the smaller panel of patients, this provides same-day or next-day appointments and the ability to spend more time with your provider at each appointment.

Don’t forget to use your health care portal on the CHI MyChart to communicate with your provider - you may not need to come in for an office visit. Many requests can be handled through the CHI MyChart portal.

For additional questions, please contact the CommonSpirit Health Benefit Contact Center at 855-475-4747 and select Option 1—available Monday–Friday, 8 a.m.–7 p.m. CT. or our DPC Administrative Assistant at 402-742-8404.

Frequently Asked Questions

What Providers can I see for Direct Primary Care Services?

Omaha Providers:
Russell Bowen, MD (Elkhorn)
Clint Gregory, PAC
William Lowndes, MD
Karen Miller, MD
Leah Ridder, APRN
Paula Walters, MD

Council Bluffs:
Micheal Keane, MD
Josalynn Swan, PAC

Lincoln Providers:
Adam Linck, MD

Grand Island Providers:
Shu-Ming Wang, MD

Kearney Providers:
Amber Rogers, APRN

Note: The provider list and availability are subject to change. Certain services provided by a non-DPC provider will not be covered.

What does my DPC Plan cover?

The DPC Plan combines a Direct Primary Care (DPC) membership for all your primary care services with the coverage for your non-primary care needs (hospital, specialty providers and emergency room services) by using one of BCBSNE’s Blueprint Network providers. Please review the Benefits at a Glance in the above section or by visiting the MyBenefits link found on EmployeeCentral.

What is covered under Direct Primary Care Services?

As long as you visit your CHI Health DPC provider, all of your encounters are covered, whether they are for preventive services, illness, injury or management of ongoing medical conditions. This includes:

  • All in-office X-rays
  • In-office procedures such as stitches for cuts or mole/lesion removal done by your direct primary provider
  • In-office labs such as urinalysis, blood count, strep, mono and influenza testing
  • The common/usual labs direct primary care providers request and manage are also covered
  • No-cost or low-cost generic medications filled at a CHI Health pharmacy

What is covered in a DPC Wellness Visit?

  • Vital signs, including blood pressure, pulse, respiratory, temperature, height and weight
  • Age-appropriate lifestyle review and screening tests done at the DPC office
  • Review of any concerns that you may have
  • Physical examination
  • Lab work (age appropriate)
  • Pap smear according to current guidelines
  • Completion of your Preventive and Biometric Screening forms
  • Recommendations on ways to improve your health and to keep you healthy

What are my options for after-hours care?

  • DPC on-call provider – always call your DPC provider FIRST for after-office hours care
  • CHI Quick Care Clinic (where available) – copay does apply
  • CHI Virtual Quick Care – unlimited virtual visits are offered 24/7 at no cost
  • CHI Priority Care – Two in-person visits per year for each member and their covered dependents when the DPC office is closed (nights - after 5 pm, weekends, above listed holidays and snow days)
  • During Clinic hours, 8 a.m. - 5 p.m., you will need to contact your DPC provider’s clinic
  • Urgent Care Clinic – visits at a BCBSNE in-network facility, a copay will apply
  • Non-emergent questions – you may use your healthcare portal on “MyChart” to communicate with your provider (which will be addressed next business day) 
  • Emergency Department – for true medical emergencies you may be seen at a BCBSNE in-network facility, a copay will apply
     

Am I covered to see other primary care providers for other services?

No, if you see a primary care provider outside of the DPC program, for Primary Care Services (family/internal medicine), the visit will not be covered. See the Benefits at a Glance or the Benefit Summary and Coverage (SBC) sections on this page or visit MyBenefits found on EmployeeCentral for listings of all other covered services.

Are Worker’s Compensation visits covered?

No, Worker’s Compensation is not covered or seen within the DPC program. These benefits are through the Worker’s Compensation plan and can be seen by another PCP or at one of our CHI Company Care locations that specialize in work-related injuries.

Can I see a specialist?

Though 80-90% of most health care needs can be covered through your DPC provider, you can see a specialist. Your DPC provider can help make appropriate specialty referrals. Specialty services are covered at a minimal copay, as long as you use a Blueprint Health network provider.

Can my children see a Direct Primary Care (DPC) Provider for primary care services?

Yes, DPC Providers can provide well-child check ups, as well as manage acute and chronic health care needs.

Can I see my OB/GYN for my well-woman exams?

Yes, exams are covered at an OB/GYN office as long as they are a Blueprint Health network provider.

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Blue Cross and Blue Shield of Nebraska is an independent licensee of the Blue Cross and Blue Shield Association. The Blue Cross and Blue Shield Association licenses Blue Cross and Blue Shield of Nebraska to offer certain products and services under the Blue Cross® and Blue Shield® brand names within the state of Nebraska.
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