PPO

Members' cost for ancillary services could change

Members' out-of-pocket costs could change for independent clinical labs, specialty pharmacies, and durable/home medical equipment and supplies beginning October 14, 2012. To be considered in network, ancillary providers must participate with the local Blue Cross and Blue Shield Plan where the services are rendered, even if the member is out of town.

Here's an example: A member goes to a doctor in the member's home state. The doctor takes a blood sample in his office but sends it to a lab out of state. For the blood test to be covered in network, the out-of-state lab must belong to the network in the home state.

If the ancillary provider or service does not participate in the local Blue Plan, members may have to pay more. So they should tell their doctor if they want to use only in-network ancillary providers. Members can also click on Find a Doctor on the member website and then choose Pharmacy>Lab/Pathology/Radiology or Medical Equipment. Members can also call the phone number on the back of their ID card and ask Member Services to check if the provider is in network.

Empire Blue Cross health insurance plans have a network of hospitals worldwide which bills Empire directly for any medical services rendered. For all outpatient and professional medical care you pay the provider and submit a claim, using the International Claim form.

Members will be advised of this change in the Healthy Solutions newsletter, that was mailed the week of September 17.

Note: Other ancillary provider types, including home infusion therapy providers, are not included in this change.

For questions regarding this communication, please contact Empire.