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.
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.
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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.
|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)
|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.