Out of Network Benefits for PPO Plans

Please note that if you u se a physician or hospital not contracted with the PPO network, you are subject to balance billing. This means that if you use an out of network provider (either a physician, hospital or laboratory) and the provider charges you in excess of the reasonable and customary charges, you are responsible to pay any applicable co-payment, deductible, coinsurance and the amount overcharged. This balance billing applies to all services and categories of coverage. If you use an out of network provider, routine services may not be covered and you are responsible for payment of all routine benefit services. If you use a network provider, you are not subject to balance billing and routine services are covered.*

Additionally, some anesthesiologists, radiologists and pathologists do not belong to the PPO network and services rendered by these providers are considered outside of the network and subject to any applicable deductible, coinsurance and balance billing.

To escape the additional financial burdens of balance billing and high out of pocket expenses, please confirm, prior to receiving treatment, with both the provider(s) and the PPO network that the provider is a network provider.

* For an exact explanation of covered services, exclusions and limitations, please refer to the Certificate of Coverage that was provided to you by your insurance carrier