The Pool has selected the BlueChoice® Network of health care providers, administered by BlueCross and BlueShield of Texas. Although you may choose any medical provider or hospital, you will save money by using providers from the BlueChoice® network. Choosing a BlueChoice® provider will cost you less money because you receive a higher level of reimbursement from the Pool policy. The provider’s rate will be based on the contracted network rate.
If you choose a BlueChoice provider, the Policy will pay a greater coinsurance rate and the BlueChoice provider’s rate will be based on the contract rate of the network. If you choose a medical provider or hospital not participating in the BlueChoice® Network, the Policy will pay a lower coinsurance rate for covered expenses and there is no Coinsurance Maximum for covered expenses from Non-Preferred Providers, including ParPlan Providers. Also, Covered Expenses of Non-Preferred Providers, paid by the Policy, will be based on the Allowable Amounts, which will be less than the provider’s billed rate. The provider may bill you for the difference between the charges paid by the Policy and the provider’s billed rate (balance billing). If this occurs, you will have a greater out of pocket expense. If you choose a ParPlan Provider, the Policy will pay the Non-Preferred Provider level of benefits, but the ParPlan Provider has agreed to: file your claims; not bill you for the difference between the ParPlan Provider’s charge and the Allowable Amount allowed under the Policy for any treatment or services; and not bill you for treatment or services that are not Medically Necessary, as determined by the Administrator.
If you are not sure of the status of your provider as a BlueChoice® provider, ParPlan provider, or non-preferred provider, please ask your provider or contact the Pool’s Administrator at 1-888-399-3856.
To search the provider network directory online, click on the link below. Once linked, select the “BlueChoice PPO Plan” product type option, and follow the instructions to locate network BlueChoice® health care providers in your area. You may also search for ParPlan providers as an alternative option.