PPO Members: Learn About Your Out-of-Network Health Care Options

This article is intended for PPO members enrolled in an employer health insurance plan.

As a Blue Cross and Blue Shield of Oklahoma PPO member, you get the highest level of benefits and have lower out-of-pocket costs by staying in your health plan’s network.

In-Network vs. Out-of-Network

If you need specialist care or other non-emergency medical services outside of those provided by your regular doctor, ask your doctor if they’re in your network.

Even if your doctor or surgeon is in your provider network, medical specialists who provide X-rays, lab tests or anesthesia services may not be.

If an out-of-network health care provider bills more than the approved charge for covered services, you may be responsible for the difference. This applies any time you get non-emergency services outside your provider network.

When members use health care providers that are out of their network, they may be subject to balance billing. Balance billing means you pay the amount that is more than the allowable charges negotiated with in-network health care providers.

So before you get non-emergency care, make sure the provider or facility is in your health plan network. You’ll receive the same quality health care you should expect from any provider at the lowest cost to you.

No Surprises Act

Balance billing means you pay the amount that is more than the allowable charges negotiated with in-network health care providers. Surprise billing is when you get an unexpected bill, like if you go to an in-network hospital but one of the doctors is not in network.

The No Surprises Act offers protection in some cases from balance billing and surprise billing.

• Emergency Services: The law protects members from balance billing in some emergency service situations.
• Professional Services: The law protects members from balance billing in some situations where the hospital or facility might be in-network, but the provider isn’t.
• Air Ambulance Services: The law protects members from balance billing in some situations when air ambulance transport was required and was received from an out-of-network provider.

Learn more about how this new federal law affects your health insurance plan.

Always Check

It’s always best to check to see if your specialist is in your network. You can use the online Provider Finder^® tool to search for doctors, hospitals, pharmacies, urgent care facilities and more. 

If your PPO coverage is through your self-funded employer’s plan, please check your summary plan description for details about how out-of-network services affect your benefits.

Originally published 11/18/2019; Revised 2022, 2023