Dec. 5, 2014

Making Networks Work

The dynamic, multi-dimensional landscape of health care reform requires a fresh perspective to help transform challenges into opportunities. With this viewpoint in mind, Blue Cross and Blue Shield of Oklahoma (BCBSOK) has introduced many new health benefit products or plans, (collectively called “plans”), on and off the Health Insurance Marketplace.

As we have noted in previous articles, BCBSOK is conducting extensive educational campaigns for new and prospective members, with particular emphasis on individuals who may be new to health care insurance. In addition to helping members navigate our broad menu of coverage options, educational materials also emphasize that, when choosing a health care plan, members are also choosing an independently contracted provider network. With the exception of emergencies, members are advised that using in-network providers and hospitals is essential to helping keep their out-of-pocket costs down.

We hope that our members will do their homework and “know their network” before seeking your services. However, it may take time for some of your patients, particularly if they are new to health care insurance, to become accustomed with how things work. For this reason, we want to stress the importance of confirming that you are considered an in-network provider for each patient, before rendering services. If you are out-of-network for the member’s particular benefit plan, you will need to inform the member that if they choose to proceed as your patient, they may be responsible for all or part of the cost of care.

From a provider perspective, we acknowledge that the increased number of  plans can seem daunting, particularly when each plan has a corresponding network that may be different from what you might expect. Please know that while we must continue to make changes in support of our goal of providing the best service to our members, we also remain committed to helping you conduct business with us easily and efficiently.

The following list includes some key reminders for you and your staff:

• Your network details are defined in your contractual agreement with BCBSOK.
• We encourage you and your staff to view our online Provider Finder^® to review and confirm the plans for which you may be considered an in-network provider.
• Also use the Provider Finder to confirm network status of other providers before directing your patients to those providers.
• As always, before providing care and services, it is critical to check eligibility and benefits to determine membership and coverage information.

If you have any questions, or if you would like to order educational materials for distribution to your patients or to display in your office, please contact your provider representative for assistance.

Checking eligibility and/or benefit information is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility, any claims received during the interim period and the terms of the member’s certificate of coverage applicable on the date services were rendered.