You want to take care of yourself. And when you need health care services to do that, you have a whole network to help.
Your health plan gives you access to many kinds of health care providers like doctors, therapists, clinics, pharmacies and hospitals.
Before you go for care, make sure the provider is in your health plan network. Those who have agreed to give care for you and other members in your health plan are called “network providers.” They may also be called “in-network providers” or “participating providers.” Others who do not have a contract in place to give care for you and other plan members are “out-of-network.”
It’s important to know the difference. By staying in the network, you can take advantage of discounted rates and avoid surprise charges. That’s because in-network health providers and your Medicare plan have agreed to a set price for each treatment or procedure in advance.
Someone who is not in the network can charge higher prices for the same care. In addition, you may have to pay a higher copay or deductible for out-of-network care. Depending on your type of Medicare plan, out-of-network care may not be covered or less than the full amount of the bill may be paid.
Follow these tips to stay in your network and keep your costs down:
Out-of-network/non-contracted providers are under no obligation to treat Blue Cross Medicare Advantage members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.
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When about to undergo surgery and a doctor unknown to you is introduced while you are 5 minutes from the OR are you supposed to stop everything while you call customer service to see if they are in your network? You don't know the surgeon or the anesthesiologist until you are prepped. This puts too much burden on the patient. Your PCP also does not select these doctors. What recourse is available?
Hello, If this has happened to you, please send us a private message and we can look into the situation for you. ~ Heather
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Last Updated 10012018Y0096_WEB_IL_CONNECT19_C