Out-of-pocket expenses

One of the many benefits of belonging to BCN is that you are free from the hassles of paperwork. The doctor, hospital or other health care provider will bill us for authorized, covered services. You simply pay any required copayment. If a provider does ask you to pay for covered services, please call Customer Service.

Copayments

A copayment is a fixed amount that you must pay for a covered service.

When you receive certain services, you may pay a copayment (a fixed dollar amount) or a coinsurance (a percentage of the BCN-approved amount) at the time you receive your medical care.

Examples of covered services that may require copayments include:

The copayment or coinsurance requirement is specified in your General Provisions and Your Benefits booklet.

Deductibles

A deductible is an amount that some members must pay for covered services before Blues’ payments begin.

If your coverage plan requires a deductible, you meet a fixed annual amount for one person or for your family before services are covered. Thereafter, you simply pay the required copayment for each covered service. As a member of a deductible plan, you will receive medical bills until you have met your annual deductible. Whenever you receive a health service, you will also receive a BCN Explanation of Benefits statement telling you how much you’ve paid toward your deductible.

You do not need to meet a deductible to receive the following covered services:

For more information about the deductible plan, see your General Provisions and Your Benefits booklet.

When you need to be reimbursed for claims

In the unlikely event that you had to pay for covered services, we will reimburse you for our share of the cost. Get an itemized bill and any medical records you can obtain to expedite payment. To be reimbursed, use the Member Reimbursement Form. Be sure to include:

Send to:

Member Claims
Blue Care Network
P.O. Box 68767
Grand Rapids, MI 49502-1658

page modified 02/06/2009