We live in California, but my husband's company is based in Oregon. We have PPO and most things do not require referral. My son needed speech and occupational therapy and we were able to get 30 sessions per year only paying a copay - these are expensive sessions we got for only $15 a week! Out of network claims are hard to get reimbursed, but it is hard to know if that is a function of the fact that Regence has to go through Blue Cross Blue Shield of California to pay it out. I have called customer service on many occasions and the reps have researched claims for me and called me back to tell me of the progress being made. On one recent claim, it did take 6 months to get reimbursed, but the rep who was working with me gave me her direct line and was friendly and helpful even after call after call.