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
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
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
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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