What you need to know about going out-of-network

Tuesday, May 22, 2018

TeamCare offers one of the most extensive networks of doctors, healthcare facilities, and hospitals in the nation, meaning you get high quality services at the lowest possible costs. 

Staying in-network ensures that you get access to the lower fees negotiated between TeamCare and in-network providers, so it makes sense to use our partner providers as much as possible. But what happens if you need to go out-of-network?

The cost of care from an out-of-network medical provider will likely be higher than the negotiated fees TeamCare offers. You will be responsible for paying the difference between TeamCare’s reasonable and customary allowance and the actual charges, in addition to any co-pays and co-insurance amounts.

That means you could pay hundreds or even thousands of dollars to an out-of-network provider. Depending on the type of provider you visit you may also incur a 10% out-of-network penalty.

Going out-of-network can also cause you to lose eligibility for the TeamCare Family Protection Benefit. That benefit requires you and your dependents to have exclusively used in-network medical providers for the previous two years in the event of your death.

If you need emergency services and go out-of-network, no penalty will apply and you will not lose your Family Protection Benefit. You will, however, still be responsible for paying amounts over the reasonable and customary allowance. 

You may use any dental or vision provider you wish without penalties, but staying in TeamCare’s network ensures you get optimal coverage and additional benefits. 

If you do need to go outside of the TeamCare PPO network to receive services, it’s likely that your provider will file your claim with TeamCare as a courtesy. If they don’t, you’ll need to submit your claim with your network. Out-of-network providers may also require you to pay out-of-pocket for services and file a claim for reimbursement.

To submit an out-of-network claim to BCBS, download and fill out the claim form here.

To submit an out-of-network claim to Medical Mutual, download and fill out the claim form here.