All other specialty providers: $30 copay.$0 copay if you use an AdvantageCare Physicians (ACPNY) provider.Coverage for in-network and out-of-network services.This chart shows the estimated cost of seeing a doctor outside of our network.
#Blue cross blue shield ppo urgent care copay professional
Using a health care professional in our network is a cost-effective way to use this plan. The calculator provides estimates for out-of-pocket costs, or what you may pay for certain items and services. If you choose to get services outside of our network, you can use our self-service treatment cost calculator available in the myEmblemHealth member portal. If you do not get a required prior approval, you may not get reimbursed. Hospitalization benefits are provided to you by Empire BlueCross BlueShield. You will be responsible for any difference between the provider’s fee and the amount of the reimbursement, in addition to deductibles and coinsurance therefore, you may have a substantial out-of-pocket expense. This plan is offered to employees and non-Medicare eligible retirees and covers medical and surgical services. Most of the reimbursement rates have not increased since that time, and will likely be less (and in many instances substantially less) than the fee charged by the out-of-network provider.
The reimbursement rates in the Schedule are not related to usual and customary rates or to what the provider may charge but are set at a fixed amount based on GHI’s 1983 reimbursement rates. When you choose to use out-of-network doctors, payment for covered services will be made under the NYC Non-Participating Provider Schedule of Allowable Charges. Using an Out-of-Network Health Care Professional In most cases, when you see a network doctor, your cost will just be a copay.
You can see any network doctor without a referral. The GHI Comprehensive Benefits Plan (CBP) gives you the freedom to choose in-network or out-of-network doctors.
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