Medical Network Resource Guide – Section 4

Simply put, receiving care from out-of-network providers is your most expensive option. You will pay more for getting care in multiple ways:

• The amount you’ll be charged is likely higher than the discounted rates offered in the health system network and by in-network providers. This is because out-of-network providers and facilities (such as HCA and Saint Luke’s) have not agreed to accept an approved amount for services from Blue Cross Blue Shield.
• Your share of the cost is more with higher coinsurance and/or copay amounts.
• You’ll need to meet a higher – and separate – deductible for out-of-network care.
  • Any money you spend on out-of-network care does not count toward your deductible. This makes out-of-network care even more costly.
  • One exception: Coinsurance for emergency room visits is applied to the in-network deductible. This is to ensure cost isn’t a barrier when care is needed most.
• You’ll have a higher – and separate – out-of-pocket maximum. It is calculated separately from the expenses that apply toward the out-of-pocket maximum for health system and in-network care.

Given the big impact on your budget, it’s important to make sure both your provider and facility is in-network – or better yet – in the health system network for the absolute lowest cost to you.