Employers

Group Administrator's Manual

True Blue PPO

True Blue PPO (preferred provider organization) is a network used by fully insured products including Arkansas Blue Cross, the Federal Employee Program and BlueCard. It is made up of doctors, hospitals and other health care professionals who sign contracts with True Blue PPO agreeing to accept our allowance to care for covered employees.

Frequently Asked Questions

Q. Can employees choose their own doctor and/or hospital?
A. Yes, employees can go to any provider they wish, whether they are PPO providers or not. However, if they go to a provider that does not participate in the True Blue PPO, Arkansas Blue Cross insurance will pay less of the doctor or hospital bills after they have met their deductible than if they had gone to a PPO participating provider. In other words, Arkansas Blue Cross will pay more of the bill after they meet their deductible if they go to a PPO participating provider.

Q. How much more money will an employee pay if they use an out-of-network doctor or hospital?
A. Normally, an employee will pay 20 percent more, depending on the group contract.

Q. Can an employee stay with their present doctor/OB-GYN/pediatrician?
A. If the present doctor, obstetrician/gynecologist, or pediatrician has contracted with True Blue PPO, the employee can remain with their doctor, and their covered charges will be paid on an in-network basis.

If their present doctor is not a PPO doctor, their charges will be paid on an out-of-network basis.

They can remain with their non-PPO doctor, but they will be paying more out-of-pocket for their covered medical and hospital charges after they meet their deductible if their doctor is not in the PPO.

Q. Why should an employer choose a PPO?
A. Health care costs are a major burden, and they continue to increase. The PPO holds down the cost of health care by finding doctors, hospitals and other participating providers who agree to accept our allowance for their services, in exchange for being part of the PPO network.

Q. What happens if an employee has an emergency medical situation and must be treated by an out-of-area doctor or hospital?
A. He or she should go to the nearest doctor, hospital or other medical facility and seek treatment for the emergency. It will be paid as an in-network (PPO) claim. Refer to your benefit certificate for definition of emergency care.

Q. What about dependents who live outside of a PPO area? Are their claims paid as in-network or out-of-network?
A. Any dependent that lives in an out-of-network area, and seeks treatment in that area, must use a participating Blue Cross Blue Shield provider, except in case of accident/emergency, for the claims to be paid as if they were in-network. If it is not an accident/emergency, claims are paid as out-of-network. In order for claims to be handled as quickly as possible, please make sure dependents are aware of how to use an in-network provider and what is considered an emergency.

Q. How can a doctor or hospital get into the PPO?
A. If a doctor or hospital wants to discuss participation in the PPO, they can contact the network development representative at the regional office.

Q. Whose responsibility is it to call to pre-certify a hospital admission?
A. It is the covered employee's responsibility to call to pre-authorize a hospital admission.

Although a covered employee's physician's office may often make the call, the employee is responsible to make sure he or she has been pre-certified for a hospital admission, whether by the covered employee personally, the doctor, or someone else, such as another member of the household.

Q. How are out-of-state employees covered?
A. Out-of-state employees who live outside our network areas are covered under a standard comprehensive major medical plan. This is true for newly enrolled groups and currently enrolled groups that change to the PPO.

Q. Does an employee have to fill out different claim forms or follow different claim filing procedures now that we are under the PPO?
A. The claim forms and claim filing procedures are the same under the PPO as under your old plan.

Q. What are the PPO areas? How does an employee know if they are in-area or out-of-area?
A. They should consult the PPO directory to see which doctors and other health professionals have contracted with the PPO. The provider directory may be accessed online at arkansasbluecross.com.

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