What does “out-of-network” mean?
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.
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.