What is the difference between in-network and out-of-network?
A8. When members choose to receive care from a Blue Cross PPO participating network provider, they pay less out of pocket (sometimes only a small copayment for each visit) and generally do not have to file claims. When the provider is not contracted with the Blue Cross PPO network, benefits are usually less and the member’s share of the costs will be higher, including deductible, coinsurance, and possibly the balance in excess of our allowance. In addition, many out-of-network providers may require immediate, full payment from the patient, requiring the patient to submit a claim to us in order to receive benefits.
A preferred provider or “in-network” provider is a doctor, hospital, or other health care provider that participates in the BCBS Student Blue Plan network. The advantage to using a preferred provider is that these providers have agreed to accept a predetermined fee or preferred allowance as payment for their services. Therefore, when you choose preferred providers, you receive the highest level of benefits under your health care plan and lower out-of-pocket expenses. You can also obtain covered services from non-preferred or “out-of-network” providers, but since these providers have not agreed to any prearranged fee schedule, your out-of-pocket costs will be higher. Also, you must pay a plan-year deductible for most out-of-network covered services.
