You and BMC Save When You Stay In-Network
You save two ways when you stay in the network because you pay:
- Lower negotiated rates for services
- Lower, in-network coinsurance
Here’s what to expect when you use out-of-network providers:
- Your share of the costs (e.g., coinsurance and deductibles) will be higher compared with what you’d pay for in-network care.
- You’ll also be responsible for all charges above the usual and customary charge. What is a usual and customary charge? When you receive out-of-network medical care from a non-participating doctor or other health care professional, there’s a limit to the amount of money that will be reimbursed. For example, your doctor might charge $125 for treatment, but the most your plan will pay is $90. This amount is called the usual and customary charge.
- Any amount above the usual and customary charge does not apply to your out-of-pocket maximum or deductibles.
Use Blue Distinction Centers for Specialty Services
Blue Distinction Centers (BDCs) are another way to help you achieve a better health care outcome and lower out-of-pocket costs. BDCs are medical facilities that have demonstrated expertise in the delivery of quality health care at a better value.
If you are enrolled in a BCBSTX plan, you and your covered family will need to use BDCs for certain specialty services, including bariatric surgery, knee and hip replacements, selected spine surgeries, and some transplant surgeries. If you live within 75 miles of a BDC and receive these services at a non-BDC facility, the plan will not cover your treatment. You’ll pay the full cost out of your pocket.
How to Find a Network Provider
You can find a list of participating providers on the BCBSTX website and on the Kaiser website, or you can contact BCBSTX and Kaiser directly by phone to request a provider directory. You can also access the applicable provider directory through the My BMC Compensation & Benefits website. Select Your Benefits Resources > Health and Insurance > TAKE ACTION — Find A Doctor.
Copyright © 2024 BMC Software. All Rights Reserved |
Disclaimer
Disclaimer:
The content on this site includes links to tools and information that are not the property of BMC Software, and BMC Software is not responsible for their accuracy, completeness or continued availability. Some of the material contained in this site is based on official plan documents. It is not, nor is it intended to be, the legal plan document or a contract between the company and any employee or contractor. Every effort has been made to ensure the accuracy of this material. In the unlikely event that there is a discrepancy between the site and the official plan documents, the official plan documents will control. BMC Software reserves the right to amend or terminate the plan(s) or program(s) at any time. If you believe the benefits do not describe those available to you, contact the Benefits Center at 877-BMC-4849.
Copyright © BMC Software. All Rights Reserved
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