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

Providers who are in your plan’s network have negotiated with your health plan on how much to charge for certain services. An out-of-network provider has not signed a contract with your health plan, so they may charge a different amount.

If an out-of-network health care provider bills more than the approved charge for covered services, they may bill you for the difference. That is called balance billing.   

No Surprises Act

Balance billing, or surprise billing, happens when you get an unexpected bill, like if you go to an in-network hospital or facility, but one of the doctors or specialists is not in your plan's 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 Provider Finder^® 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, 2024