![]() Our staff remains available to assist with these benefit inquiries as needed. Preauthorization indicators and contactsįor some patients, your web transactions may instruct you to call BCBSIL Provider Customer Service to obtain benefit details.Out-of-pocket (original and remaining amounts).Deductible (original and remaining amounts).With Availity’s Eligibility and Benefits Inquiry, users can access printable results that include up to date benefit information. Providers are strongly encouraged to use the Availity ® Essentials or their preferred vendor for eligibility and benefit verifications. When services may not be covered, members should be notified that they may be billed directly. It’s strongly recommended that providers ask to see the member’s ID card for current information and photo ID in order to guard against medical identity theft. Eligibility and benefit quotes include membership verification, coverage status and other important information, such as applicable copayment, coinsurance and deductible amounts. If you elect the PPO Plan, BU will contribute an amount to your Health Care FSA that can be used to pay for eligible out-of-pocket expenses, like your deductible.Patient eligibility and benefits should be verified prior to every scheduled appointment. In the PPO Plan, separate out-of-pocket maximums apply to medical expenses and prescription drug expenses, as follows: Expense The annual out-of-pocket maximum limits the amount you pay for the deductible, copays and coinsurance each calendar year. X-rays, labs and related diagnostic tests The coinsurance percentage you pay depends on the type of service and the provider you choose: ExpenseĬoinsurance Percentage You Pay (after deductible)īlue Cross Blue Shield Low and High Cost Hospital Services Copays apply to the following expenses: Expenseįor most eligible expenses, once you meet the annual deductible, you and the plan pay a percentage of the cost of care. Copays do not count toward the deductible but do count toward the out-of-pocket maximum. It then pays benefits for all covered family members when the family deductible amount is met by any combination of the remaining covered family members.Ĭopayments or “copays” are a flat fee that applies for doctor’s office visits, emergency room visits and prescription drugs. Spouse and dependent coverage: The plan begins paying benefits for a covered person when he or she meets the individual deductible amount. ![]() Individual Coverage: The Plan begins to pay benefits when the individual deductible is met. The deductible that applies depends on the network you choose and your coverage level: Deductible Annual Deductibleįor most eligible expenses, you pay the full amount until you reach the annual deductible. There are procedures to follow when making out-of-network claims and when appealing a denied claim. You need to follow some procedures when dealing with emergency care, whether within or outside the enrollment area. When you participate in the BCBS PPO, you must follow a benefit management process. The high-cost hospital list may change from time to time. However, if you receive certain covered services from any of the preferred general hospitals, you pay the highest in-network cost sharing level. For most preferred general hospitals, you will pay the lowest in-network cost sharing level. As a member in this plan, you will pay different levels of in-network cost share (such as copayments and/ or coinsurance) for certain services depending on the preferred general hospital you choose to furnish those covered services. This health plan option includes a tiered network feature called Hospital Choice Cost Sharing. These are called your out-of-network benefits. You can also choose non-preferred providers, but your out-of-pocket costs are higher. These are called your in-network benefits. You receive the highest level of benefits under your health care plan when you choose preferred providers. The amount of coverage depends on where you receive treatment. There are two levels of coverage: in-network and out-of-network. When you join the BCBS PPO, you are not required to choose a primary care physician. The BCBS PPO is a preferred provider organization (PPO) that combines the advantages of a national network with the option to use physicians and facilities outside the network, but at a higher cost. Employee Perks, Discounts and Resourcesīlue Cross Blue Shield PPO A 5-minute narrated video explaining How the BCBS PPO Works.Headspace for Meditation and Mindfulness. ![]()
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |