Page 31 - Touching All the Bases- Power point 2023 Umpires_Neat

Will you pay less if Yes. See www.highmarkbcbs.com/find-a-doctor or call This plan uses a provider network. You will pay less if you use a provider in the
you use a network 1-800-701-2324 for a list of network providers. plan’s network. You will pay the most if you use an out-of-network provider, and you
provider? might receive a bill from a provider for the difference between the provider’s charge
and what your plan pays (balance billing).
Be aware your network provider might use an out-of-network provider for some
services (such as lab work). Check with your provider before you get services.
Do you need a No. You can see the specialist you choose without a referral.
referral to see a
specialist?

All copayment and coinsurance costs shown in this chart are after your overall deductible has been met, if a deductible applies.

What You Will Pay
Common Medical Services You May Need Limitations, Exceptions, & Other
Event Network Provider (You Out-of-Network Provider Important Information
will pay the least) (You will pay the most)
If you visit a Primary care visit to treat an injury or $30 copay/visit 30% coinsurance You may have to pay for services that
health care illness aren’t preventive. Ask your provider if
provider’s office Specialist visit $30 copay/visit 30% coinsurance the services needed are preventive.
or clinic Preventive care/screening/immunization No charge 30% coinsurance Then check what your plan will pay
Deductible does not apply for.
to immunizations.
Please refer to your preventive
schedule for additional information.
If you have a test Diagnostic test (x-ray, blood work) No charge 30% coinsurance Copayments, if any, do not apply to
Imaging (CT/PET scans, MRIs) No charge 30% coinsurance Diagnostic Services prescribed for
the treatment of Mental Health or
Substance Abuse.
Precertification may be required.

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