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Understanding who accepts your insurance

We work with certain doctors, hospitals and specialists to offer a member discounts for your care. They make up your provider network. We have several networks – you can see yours listed on the front of your Member ID card. Look for Blue Network MSM, Blue Network PSM or Blue Network SSM.
It's in the Details.

You pay less when you see providers in your network

Your share of the cost is lower when you go to providers in your network. That’s because those doctors, hospitals and specialists offer a member discount for your care. When you see an out-of-network provider, you may have to pay more, and in some cases the full cost* of your care.

*2019 On/Off-Marketplace individual plans don’t include non-emergent benefits for out-of-network care. If you have one of these plans, you’ll pay the full cost of care you get from providers who aren’t in your network. Please see more about these plans here.

An example of In-Network vs. Out-of-Network costs

If you use a doctor or hospital outside your network, you could pay higher copays, coinsurance and/or deductibles, even in an emergency.

The provider(s) can also make you pay the difference between their usual charge and what we’ve 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 your provider 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 Network S insurance?”
  • 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 referred providers are in your network before accepting services from them.

How to find providers in your network

Some providers are in one of our networks, but not in another. It’s easy to find out if your current doctors are in Network S, or to find new providers who are. Just go to our Find a Doctor tool and choose your network from the drop down menu, or sign in to your BlueAccessSM account. You can also call us at the number on the back of your Member ID card and we’ll be glad to help.

Getting care outside Tennessee

If the front of your Member ID card shows a suitcase logo with the letters PPO inside, your health plan covers you anywhere outside of the state and in nearly every country and territory around the world. All you need to do is choose providers and facilities in the BlueCard® Network.* Find out more about the BlueCard program here.

Finding out of state providers is easy, too – just go to our Find a Doctor tool and choose BlueCard PPO (Outside of Tennessee) from the drop down menu, or sign in to your BlueAccess account.

*2019 Individual On and Off Marketplace members have limited or no benefits except when receiving services from a BlueCard PPO network provider.