• Stay in or go out? Know the impact before you make your choice.

  • IN- AND OUT-OF-NETWORK PROVIDERS
    For the PPO $aver/HSA and PPO Super $aver/HSA Plans
    Understand the advantages of the Blue Shield provider networks.

    Provider networks are groups of doctors, hospitals, and other health care facilities that have a fee arrangement with your medical plan. That means when you receive care from an in-network provider, you will, in most cases, save money.

    How Networks Benefit

    Provider networks agree to charge participants a negotiated — and often discounted — rate for services and treatment. In return, they may benefit from an increase in patients.

    How You Benefit

    For the PPO $aver/HSA and PPO Super $aver/HSA Plans, when you select a Blue Shield provider, you pay lower costs. You may also benefit from other advantages, such as having access to benefits including 100% paid preventive care services when received in-network.

    How Networks Benefit
    How Networks Benefit:

    Provider networks agree to charge participants a negotiated — and often discounted — rate for services and treatment. In return, they may benefit from an increase in patients.

    How You Benefit
    How You Benefit:

    For the PPO $aver/HSA and PPO Super $aver/HSA Plans, when you select a Blue Shield provider, you pay lower costs. You may also benefit from other advantages, such as having access to benefits including 100% paid preventive care services when received in-network.

  • IN- AND OUT-OF-NETWORK PROVIDERS
    For the PPO $aver/HSA and PPO Super $aver/HSA Plans
    Compare the differences.

    Click below to see why it matters if you stay in-network or go out-of-network.

    In-Network

    You pay less when you use network providers.

    Out-of-Network

    You pay more when you use out-of-network providers.

     

    In-Network

    In-network providers will file all claims for you.

    Out-of-Network

    You may have to pay for services up front and submit a claim for reimbursement afterwards.

     

    In-Network

    The PPO $aver/HSA and PPO Super $aver/HSA Plans have several programs to ensure the providers are of high quality.

    Out-of-Network

    The PPO $aver/HSA and PPO Super $aver/HSA Plans' quality programs do not cover out of network providers.

     

  • IN- AND OUT-OF-NETWORK PROVIDERS
    For the PPO $aver/HSA and PPO Super $aver/HSA Plans
    Check the price tag.

    See why going out-of-network will cost you more.

    You pay less in-network because:
    • Blue Shield providers have agreed to charge you lower fees.
    • The portion of these fees that you pay through coinsurance is less.
    You pay more out-of-network because:
    • No fee arrangement has been negotiated and providers can charge you full rates.
    • Fees may be more likely to be above your plan’s usual, customary, and reasonable (UCR) limits.
    • The portion of these costs that you pay through coinsurance is more.
    In-Network
    You pay less in-network because:
    • Blue Shield providers have agreed to charge you lower fees.
    • The portion of these fees that you pay through coinsurance is less.
    Out-of-Network
    You pay more out-of-network because:
    • No fee arrangement has been negotiated and providers can charge you full rates.
    • Fees may be more likely to be above your plan’s usual, customary, and reasonable (UCR) limits.
    • The portion of these costs that you pay through coinsurance is more.

    What are the negotiated fees? What is coinsurance? Are you in an HMO? What are UCR limits?

  • IN- AND OUT-OF-NETWORK PROVIDERS
    For the PPO $aver/HSA and PPO Super $aver/HSA Plans
    Additional Resources
  • IN- AND OUT-OF-NETWORK PROVIDERS
    For the PPO $aver/HSA and PPO Super $aver/HSA Plans
    Now You Know! Here's a quick quiz to help you remember the information when you need it most!
    Select In-Network or Out-of-Network to test your knowledge!

    You can benefit from programs designed to establish provider quality standards and identify the best medical specialists and centers of excellence.
    In-Network Out-of-Network

    You'll pay less throughout the year because of negotiated provider fees, lower deductibles, and higher out-of-pocket maximums.
    In-Network Out-of-Network

    When you need services, your claim may not be filed by the provider — you will likely need to pay up front and submit a claim for reimbursement.
    In-Network Out-of-Network

    You can benefit from programs designed to establish provider quality standards and identify the best medical specialists and centers of excellence. In-Network Out-of-Network

    You'll pay less throughout the year because of negotiated provider fees, lower deductibles, and higher out-of-pocket maximums. In-Network Out-of-Network

    When you need services, your claim may not be filed by the provider — you will likely need to pay up front and submit a claim for reimbursement. In-Network Out-of-Network

    Convenient online tools will help you locate these types of providers. In-Network Out-of-Network