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What is Out-of-Network Coverage?

 

For Consumer Choice HSA and Comprehensive Care Members

Out-of-network care will be covered at 60 percent of the negotiated rate, subject to any deductibles. In this case, you will be subject to balance billing. Balance billing is the process where the provider bills the patient for the remaining portion of the full charge that BCBSGa did not pay.

Example: Out-of-network Piedmont ER visit
Full Rate = $1,200*
BCBSGa negotiated rate = $500*


BCBSGa will pay 60 percent of the BCBSGa negotiated rate, or $300

Piedmont will then balance bill the patient $900 as the remaining amount of the Full Rate

*Not actual amounts; used for example purposes only. These amounts could be higher or lower than shown.

 

For BlueChoice HMO Members

Out-of-network care is not covered under the BCBSGa HMO plan. Employees enrolled in the BCBSGa HMO plan would be responsible for the full cost of care.

 

For All Members

To determine if any of your physicians or providers are affiliated with Piedmont Healthcare, use the Piedmont Healthcare Physician search tool. To avoid incurring the higher costs of using an out-of-network doctor, use the “Find a Doctor” tool on the BCBSGa microsite to find in-network physicians. You will be able to find a listing of in-network BCBSGa doctors and facilities in your area by sorting the type of doctor or specialty. You also will want to confirm that the doctor you choose is not represented in the Piedmont Healthcare Physician search tool.

 

Revised 4/3/2018