Blue Cross and Blue Shield of Illinois

 

August 23, 2013

Illinois PPO Network Changes for Autism Providers

We want to inform you that effective Sept. 1, 2013, the following provider types will be eligible to participate in the PPO network to provide services for individuals with Autism:

  • Board Certified Behavioral Analysts (BCBAs), certified by the Behavior Analyst Certification Board
  • Developmental Therapists who participate in the State of Illinois Early Intervention Program

For members, this means that if their benefit plan is eligible for state-mandated Autism coverage and their current (or future) provider is not part of the Blue Cross and Blue Shield of Illinois (BCBSIL) PPO Network as of Sept. 1, 2013, their claim will be processed as out-of-network for services rendered on or after Sept. 1, 2013.

If members are unable to change providers at this time, they will be allowed a 60-day transition period. If members receive an Explanation of Benefits (EOB) statement that shows services prior to Oct. 31, 2013, being covered at the non-PPO level, they may contact customer service to review the claim.

After Oct. 31, 2013, if the provider is not contracted and participating in the PPO network, the claim will be paid at the out-of-network benefit level, and members will be financially responsible for the amount billed that exceeds the allowed amount.

If a member’s plan is not eligible for state-mandated coverage for Autism services, then claims will be processed based on his or her benefit plan. The addition of BCBAs and Developmental Therapists does not change the benefits available under a member’s plan.

Over the last year, BCBSIL has made a concerted effort to establish contracts with many of the providers mentioned above.

Members who have obtained Autism-related services in the last 12 months will be notified of this change (see letter). They will also receive a list of providers who will be in the PPO Network as of Sept. 1, 2013, and have identified themselves as providing treatment for Autism. They will also receive instructions for looking up providers using the Provider Finder® tool or by calling customer service.

 
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A Division of Health Care Service Corporation, a Mutual Legal Reserve Company,
an Independent Licensee of the Blue Cross and Blue Shield Association.