Bakery Drivers Local 734 - Health and Welfare Fund | Your BCBSIL Hospital/Doctor PPO
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Your BCBSIL Hospital/Doctor PPO

Your BCBSIL Hospital/Doctor PPO

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:

  • Call BCBSIL at 1 (800) 810-BLUE;
  • Visit the BCBSIL website at www.bcbsil.com; or
  • Call the Fund Office at (773) 594-2810

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

    • Be sure to show the doctor or hospital your BCBSIL PPO I.D. card. Failure to show your I.D. card could cause a delay in claim processing.

 

  • BCBSIL PPO providers should not ask you to make payment up front unless you have failed to show your BCBSIL I.D. card. (If you show your card and a BCBSIL PPO provider asks you for payment, please contact the Fund Office immediately.)

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.

  • The rules of the Medical Care Review Program apply whether or not BCBSIL PPO providers are used.

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

Out-of-Network Hospitals
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:

  • Out-of-network providers can charge you more than the BCBSIL negotiated rates, and you will be responsible for the excess amounts.
  • In addition, your co-payment percentage shares for out-of-network hospital and doctor expenses will not apply to your out-of-pocket limit, and the Plan will not pay 100% for out-of-network expenses after your out-of-pocket limit is met.