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Q:

What does "out-of-network" mean?

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Out-of-network services are services provided by doctors and hospitals that have not contracted with BCBSNM or with other Blue Cross and Blue Shield companies. Out-of-network providers may have other contracts with their local BCBS, but not "preferred" or "PPO" contracts. For most benefits, after your clients have met the deductible for services from a Nonpreferred Provider, they will pay a percentage of covered charges for services they receive from Nonpreferred Providers. If the covered charge is less than the amount a Nonpreferred Provider bills, the provider may bill your clients for the balance. (Some Nonpreferred Providers may have other types of contracts with BCBSNM and will also write off the amount over the covered charge.) Some BCBSNM plans do not cover services from Nonpreferred Providers, except for emergency services. See the Summary of Benefits. more
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Out-of-network services are services provided by doctors and hospitals that have not contracted with BCBSNM or with other Blue Cross and Blue Shield companies. Out-of-network providers may have other contracts with their local BCBS, but not "preferred" or "PPO" contracts. For most benefits, after you've met the deductible for services from a Nonpreferred Provider, you will pay a percentage of covered charges for services you receive from Nonpreferred Providers. If the covered charge is less than the amount a Nonpreferred Provider bills, the provider may bill you for the balance. (Some Nonpreferred Providers may have other types of contracts with BCBSNM and will also write off the amount over the covered charge.) Some BCBSNM plans do not cover services from Nonpreferred Providers, except for emergency services. See your Summary of Benefits. more
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Your health care coverage is considered out of network when you visit a doctor or hospital that does not participate in our network. With an HMO plan, you only have coverage for in-network providers, while PPO plans allow you the freedom to see both in- and out-of-network providers. more
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Out of network means any health care provider who does not belong to the Beech Street group. By seeing someone who is out of network, insurance will cover only 60% of what is reasonable and customary after the co-pay is paid. The student will be responsible for 40% of the bill.
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