empire blue cross blue shield copay and coinsurance

#Empire blue cross blue shield copay and coinsurance full
#Empire blue cross blue shield copay and coinsurance professional

Surprise medical bills could cost thousands of dollars depending on the procedure or service. This can happen when you can’t control who is involved in your care - like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider. “Surprise billing” is an unexpected balance bill. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your plan’s deductible or annual out-of-pocket limit.

#Empire blue cross blue shield copay and coinsurance full

Out-of-network providers may be allowed to bill you for the difference between what your plan pays and the full amount charged for a service. “Out-of-network” means providers and facilities that haven’t signed a contract with your health plan to provide services. You may have additional costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network. When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, like a copayment, coinsurance, or deductible. What is “Balance Billing” (Sometimes Called “Surprise Billing”)? In these cases, you shouldn’t be charged more than your plan’s copayments, coinsurance, and / or deductible. When you get emergency care or are treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from balance billing. This coverage is provided pursuant to a contract entered into in the state of Michigan and shall be construed under the jurisdiction and according to the laws of the state of Michigan.Your Rights & Protections Against Surprise Medical Bills Payment amounts are based on the BCN-approved amount, less any applicable deductible, copay and/or coinsurance amounts required by the plan. In the event of a conflict between this document and the applicable certificate and riders, the certificate and riders will rule. A complete description of benefits is contained in the applicable Blue Care Network certificate and riders. Additional limitations and exclusions may apply to covered services.

This document is intended to be an easy-to-read summary.

#Empire blue cross blue shield copay and coinsurance professional

Conditions covered by workers’ compensation or similar law services or supplies not specifically listed as covered under your benefit plan services received before your effective date or after coverage ends services you wouldn’t have to pay for if you did not have this coverage services or supplies that are not medically necessary physical exams for insurance, employment, sports or school any amounts in excess of BCN’s approved amount cosmetic surgery, admissions and hospitalizations dental care, dental implants or treatment to the teeth except as specifically stated in your benefit plan hearing aids infertility-related drugs private duty nursing telephone, fax machine or any other type of electronic consultation educational services, except as specifically provided or arranged by BCN or specifically stated in your benefit plan care or treatment furnished in a nonparticipating hospital, except as specifically stated in your benefit plan personal comfort items custodial care services or supplies supplied to any person not covered under your benefit plan services while confined in a hospital or other facility owned or operated by state or federal government, unless required by law voluntary abortions or vasectomy reversals RK, PRRK, or Lasik services provided by a professional provider to a family member services provided by any person who ordinarily resides in the covered person’s home or who is a family member any drug, medicine or device that is not approved by the Food and Drug Administration, unless required by law vitamins, dietary products and any other nonprescription supplements except as specifically stated in your benefit plan dental services, except for dental injury appliances, supplies or services as a result of war or any act of war, whether declared or not communication or travel time, lodging or transportation, except as stated in your benefit plan foot care services, except as stated in your benefit plan health clubs or health spas, aerobic and strength conditioning, work-hardening programs and related material and products for these programs hair prosthesis, hair transplants or implants experimental treatments, except as stated in your benefit plan and alternative medicines or therapies.