Using Network Providers Protects Your Wallet

Navigating Health Care

Using Providers who are in the Blue Cross Network Protects Your Wallet

Did you know that you may pay significantly more for care you receive from out-of-network providers?

The providers in the Blue Cross network, those we call “network providers,” agree to accept reasonable payment for services and supplies, also known as the “allowed amount.” We prohibit our network providers from billing our members for costs that exceed the allowed amount, so you pay only your plan’s deductible, co-payments, or co-insurance for the in-network covered care you need.

The allowed amount is our way of protecting you—and your wallet—from excessive health care costs and bringing you some peace of mind and the ability to budget for expenses.

In addition to these financial agreements, our network providers agree to comply with academic credentialing, quality, and safety requirements in order to participate in our network.

We process all claims based on the allowed amount, whether you see a network provider or an out-of-network provider. We update our allowed amounts periodically. When you are planning a visit to a specialist, call our customer service team at the number on the back of your ID card so you have all the information you need before you go.

When you seek care with out-of-network providers, we can’t protect you from excessive health care costs. Because out-of-network providers have no contractual agreements with Blue Cross and Blue Shield, they can bill you for the balance of the total bill when it exceeds our allowed amount. These excess costs add up quickly and mean that you will pay more than your plan’s out-of-pocket maximum for the year. Excess balances from out-of-network providers can range from less than $100 up to $100,000 or more!

In the waning days of 2020, Congress passed a new law that takes steps to protect patients against these surprise bills, but we believe the law does not go far enough to protect our members. If the provider gives you notice of their network status and an estimate of charges 72 hours prior to receiving out-of-network services—and you provide consent to receive that care—you will be responsible for the full amount of the bill. Before you consent to out-of-network care, call our customer service team to get a list of your network providers. That extra step will be well worth your time.

Tips to protect you and your wallet:

1: Use network providers when seeking care. Use our Find a Doctor tool to find providers in our network, or contact our customer service team for assistance. We are here to help you navigate your care.

2: Do your homework before you seek care. Make sure your plan covers the service or supply before you go to your provider’s office. Be sure to review any prior approval requirements in advance. A good place to start is our Member Resource Center. If you seek care for a service or supply that your plan does not cover at all (even if your provider is a network provider), you will pay for the entire cost of the service or supply. A quick call to customer service can protect your wallet.

3: When you have an emergency, seek care right away! In an emergency, we cover your emergency care as if you had been treated by a network provider. While you will still pay your plan’s deductible, co-payments, and/or co-insurance, we will help to protect you from surprise balance billing for excessive costs. If an out-of-network provider bills you for more than your deductible, co-payment, or co-insurance for emergency care, contact our customer service right away.

We understand that budgeting for health care expenses can be difficult. Follow these tips and know that our customer service team is just a phone call away to help you navigate your health care journey. Our representatives are available to help Monday through Friday, 7 a.m. to 6 p.m. at the number listed on the back of your ID card.