Out-of-Network Benefits
We cover the cost of “in-network” services differently than “out-of-network” services. We want to help you understand how we pay for your out-of-network care. Most importantly, we want to make clear how out-of-network care results in higher costs for you.
NOTE: Network language may vary by product line including preferred/non-preferred, participating/non-participating in-network/out-of-network.
Out-of-Network compared to In-Network
The diagram below outlines the differences between out-of-network and in-network providers. As you see, the use of an out-of-network provider means more responsibility for you and increased costs.
Click image to view larger
Claim Example - See your savings!
The example below illustrates the cost savings a managed health plan member may experience by receiving benefits form an in-network provider versus an out-of-network provider.
| In-Network Provider |
Out-of-Network provider |
|
|---|---|---|
| Total cost of Office Visit: | $238.65 | $238.65 |
| BCBS Allowed Price: | $104.59 | $0.00 |
| BCBS Amount Paid: | $79.59 | $0.00 |
| Member Benefit Applied: | $25.00 (Office Visit Co-pay) |
$0.00 |
| Additional balance billed by Provider: | $0.00 | $0.00 |
| Total Member Cost: | $25.00 | $238.65 |
Whether you are enrolled in a managed or unmanaged health plan, the cost savings for using in-network providers is substantial.
To view a more specific example of the cost savings you may experience, login to the Member Resource Center.
