This article is intended for PPO members enrolled in an employer health insurance plan.
Blue Cross and Blue Shield of Oklahoma (BCBSOK) PPO members get the highest level of benefits and have lower out-of-pocket costs by staying in network.
If you need specialist care or medical services outside of those provided by your regular doctor, like lab work, X-rays or anesthesia, don’t hesitate to ask your doctor whether those services and providers are within your BCBSOK PPO network.
Blue Cross and Blue Shield of Oklahoma PPO members should know that if an out-of-network health care provider bills more than the approved charge for covered services, you are responsible for the difference.
Think about this scenario: Your physician has advised surgery for you. You’ve made certain that the surgeon is in your network, but have you checked the network status of your anesthesiologist?
Even if your doctor or surgeon is in network, medical specialists who provide X-rays, lab tests or anesthesia services may not be a part of your provider network.
When PPO members use health care providers that are out of their network, they are subject to balance billing. Balance billing means you pay the amount that is more than the allowable charges negotiated with in-network health care providers.
This applies any time you get services outside your provider network, including emergency services or referral services.
Members who get care from health care providers in their network will have lower out-of-pocket costs.
Always check to see if your specialist is in your network. You can use the online Provider Finder® tool or call the customer service number on your member ID card.
If your PPO coverage is through your self-funded employer’s plan, please check your summary plan description for details about how out-of-network services affect your benefits.