Understanding Networks

How Blue Networks℠ save you money

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What's a Network?

Important Information

We’re simplifying our individual medical plans for 2017. All our 2017 plans will feature Blue Network SSM, our most popular provider network. If you currently have an individual medical plan On or Off the Marketplace with Blue Network ESM or Blue Network PSM, we can help you find local providers in Blue Network S. We’re here to help.

When you choose a health plan, you also choose a group of doctors, hospitals and other providers you can use when you need care. This group is known as your network. We work with these doctors, hospitals and other providers so you can get care at special negotiated rates.

Why You Should Use Providers in Your Network

You can save on health care costs by staying in network. By going to in-network doctors and hospitals, you pay lower copays and avoid other out-of-network costs.

If you use a doctor or hospital outside your network, your insurance pays less and you pay more, including higher copays, coinsurance and/or deductibles. This applies even in an emergency situation.

The provider can also bill you the difference between their usual charge and the amount BlueCross agreed to pay – known as "balance billing."

Here's an example of how you avoid paying more with in-network providers:

Hospital Bill:

$20,000

Blue Network Discount:

-$9,000

Maximum Allowable Charge:

$11,000

BlueCross Pays:
(or 80% of the Maximum Allowable Charge)

-$8,800

You Pay:
(or 20% of the $11,000 Maximum Allowable Charge)

$2,200

Here’s an example of how you pay more with out-of-network providers:

Hospital Bill:

$20,000

Blue Network Discount:

None

Maximum Allowable Charge:

$11,000

BlueCross Pays:
(or 50% of the Maximum Allowable Charge)

$6,600

You Pay:
(or 40% of the $11,000 Maximum Allowable Charge, plus the $9,000 difference in the hospital’s billed charge and the Maximum Allowable Charge)

$13,400

Three Tips for Using Provider Networks

Staying in network can be complicated, so here are three tips for staying in network:

  • Show your Member ID card each time you see a network provider. Your Member ID card has helpful information such as copay amounts, if applicable, and your plan’s network distinction.

  • Before requesting services from a health care provider, make sure he or she is in your network. For example, you can ask the provider, “Do you accept BlueCross BlueShield of Tennessee members in Network S?”

  • Don't assume your doctor will only refer you to specialists, hospitals and/or other health care providers in your network. Try to make sure all of referred providers are in your network before accepting services from them.

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