THE IMPORTANCE OF STAYING IN-NETWORK
By Candice Stark, Co-Administrator
In the ever- increasing confusion of our health care world, coupled with the crippled economy, people are searching for ways to maintain their health with the least out-of-pocket cost to them. For our members with the NOITU Comprehensive Plan, the best advice would be to find in-network providers.
An in-network provider is defined as :
a doctor, a lab or a hospital which has entered into an agreement with a Preferred Provider Organization (PPO) to provide services at an agreed upon cost.
In our case, our PPO is the Blue Cross/Blue Shield Blue Card PPO. Blue Cross/Blue Shield has negotiated contracts with thousands of doctors, labs and hospitals. These contracts specify the amount of money that the doctors, labs or hospitals will receive for their different services. As a result of these contracts, you have the peace of mind knowing that if you select a participating provider through the extensive Blue Cross/Blue Shield network, you will not incur out-of-pocket costs, with the exception of a small co-pay in some cases.
How do you find an in-network provider? There are three ways.
1. Call Blue Cross/ Blue Shield at 1-800-810-BLUE. Ask them to help you locate a participating provider near you. This applies to doctors, labs and hospitals. If you need a doctor who specializes in a particular field of medicine, you must indicate that to the representative. Make sure to have the NXU number on your health benefit card available.
2. Go online at empireblue.com. Again, you will need your NXU number as well as the information indicated above.
3. Call the NOITU Member Services Department at 718-291-3434, Option 3. Again, please have the above information handy to help us to help you.
An important DO
Once you obtain the name of the in-network provider, it is imperative that you DO ask the following question when you call to set up an appointment:
“Do you participate with the Blue Cross/Blue Shield Blue Card PPO network?”
The answer to the above question must be yes in order to be confident that you will not be balance billed.
A few important DON’T’s
Don’t be fooled if the provider’s office states that they “accept” your insurance. Merely accepting the Fund’s payment does NOT mean that they will accept the payment as” payment in full”, and not balance bill you. Be persistent and don’t be afraid to ask!
Don’t assume that just because you made sure that the hospital and surgeon participate with the Blue Cross/Blue Shield Blue Card PPO network that the anesthesiologist and assistant surgeon also participate. Be persistent, and don’t be afraid to ask!
Don’t assume that just because one doctor in a multiple-practice office participates with the Blue Cross/Blue Shield Blue Card PPO network that all of the doctors participate. Make sure that the specific doctor with whom you have the appointment participates. Be persistent, and don’t be afraid to ask!
Receiving a balance bill and incurring large out-of-pocket costs is very difficult, if not impossible, to overcome later.
