Preferred Provider Organization (PPO) coverage is most effective and advantageous
for a member when the member receives covered healthcare services from a preferred
or "in-network" provider. Claims for services provided by preferred providers may
have a more advantageous deductibles, coinsurance and copays than claims for services
that are performed by non-preferred, or "out-of-network" provider.
PPO or in-network deductibles, coinsurance and copays are applied to allowable charges
for services and supplies members receive from preferred providers, unless the Schedule
of Benefits or a policy shows a different deductible, coinsurance or copay for the
Reimbursement for services by non-preferred providers generally will be less than
payment for the same services if they had been provided by a preferred provider,
and could result in substantial additional out-of-pocket expense to the member.
Non-PPO or out-of-network deductibles, coinsurance and copays are applied to allowable
charges for services and supplies members receive from non-preferred providers,
Notification to Arkansas Blue Cross and Blue Shield of requests for payment of out-of-network
services or supplies at in-network benefit level should be made by writing to:
Arkansas Blue Cross and Blue Shield
Attention: Medical Audit and Review Services
PO Box 3688
Little Rock, AR 72203
Requests should be received at least 15 working days prior to your receipt of such
services or supplies.
No Balance Billing from Preferred Providers and Contracting Providers. Preferred
providers and contracting providers are physicians or hospitals who are paid directly
by Arkansas Blue Cross and have agreed to accept Arkansas Blue Cross's payment for
covered services as payment in full except for your deductible, coinsurance, copay
and any specific benefit limitation, e.g. home health visits are limited to 50 per
year. A covered person is responsible for a provider’s billed charges in excess
of Arkansas Blue Cross's payment when non-preferred or non-contracting providers
render covered services. This is sometimes referred to as “balance billing” by non-preferred
and non-contracting providers, and these excess charges could amount to thousands
of dollars in additional out-of-pocket expenses to the covered person.
Members have a choice to receive covered dental services from either a participating
or non-participating dentist our dental network.
USAble Mutual Insurance Company has a contracted network of participating dentists.
These dentists have signed an agreement with us to accept the allowance established
for covered dental procedures as payment in full up to the member's calendar-year
maximum, plus any deductibles, coinsurance or copayments due from the member per
Non-participating dentists have not signed an agreement with us to accept our allowance
as payment in full and may balance bill a member for any amounts in excess of our
allowance in addition to any deductibles, coinsurance, copayments due (or after
the member's calendar-year maximum has been met) from the member per the policy.
Emergency services received from a non-participating dentist are not exempt from
balance billing and any cost sharing as described above.
Arkansas Blue Cross and Blue Shield is an Independent Licensee of the Blue Cross and Blue Shield Association and is licensed to offer health plans in all 75 counties of Arkansas.
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