The Trustees of your Plan have a contract with the Blue Cross and Blue Shield of Illinois Preferred Provider Organization (BCBSIL PPO) which allows you and your covered dependents to receive inpatient and outpatient care from BCBSIL PPO doctors and hospitals (PPO providers) at negotiated rates. You don’t have to use the PPO providers – the choice of a doctor or hospital is solely up to you. However, if you do, the Plan will save money because you will avoid the out-of-network hospital deductible, and your out-of-pocket expenses will, in most cases, be lower.
You should already have received information about the BCBSIL PPO doctor and hospital networks, BCBSIL I.D. cards and a list of hospitals and facilities that participate in the BCBSIL PPO. You can call BCBSIL or the Fund Office to get another I.D. card or to request additional information about the BCBSIL PPO.
Finding BCBSIL PPO Hospitals And Doctors
The list of providers in the BCBSIL PPO is provided to all participants automatically, without charge, as a separate document. In addition, for a current list of PPO hospitals or the name of a PPO doctor near you, you can:
Since the PPO providers change from time to time, you should call the provider to verify their continued participation in the BCBSIL PPO before receiving the services.
If you use a listed hospital that no longer participates in the BCBSIL PPO, the out-of-network hospital deductible will apply.
Using BCBSIL PPO Providers
Because of the negotiated rates, you will not be able to determine the amount you are responsible for before the claim has been processed by BCBSIL. Wait until you receive an Explanation of Benefits showing the amount you are responsible for before paying a bill from a PPO provider.
All doctors and hospitals must send their bills directly to Blue Cross and Blue Shield of Illinois at the address shown on your BCBSIL I.D. Card.
What Happens If You Use An Out-of-Network (Non-PPO) Provider
IMPORTANT – Out-of-Network Surgical Centers –
The Plan excludes all charges by non-PPO surgical centers
Each time you or a covered family member goes to an out-of-network hospital for a non-emergency inpatient stay or for non-emergency outpatient care, an additional deductible ($250 under the Active Plan and $300 under the Retiree Comprehensive Plan) will apply to the covered medical expenses incurred for the care. Any such deductibles are in addition to the person’s calendar year deductible. This deductible does not apply if the treatment was due to an emergency, to treatment for chemical dependency or mental/nervous disorders, or if the person lives outside the state of Illinois.
Services Received at a PPO Hospital
Covered hospital-based services provided at a PPO Hospital will be paid as PPO claims even if the provider is out-of-network (example, a pathologist or radiologist).
All Other Out-of-Network Providers
When you use a provider that is not in the BCBSIL PPO network, your out-of-pocket share of the expenses will most likely be higher because: