Non-Network Providers
Under the Plan, you may also go to any non-network doctor or hospital at any time. However, these doctors and hospitals do not participate in the Prudent Buyer PPO network and have not agreed to negotiated rates. If you seek care from a provider who does not participate in the network, you receive reimbursement at a lower level.
Please remember, you have a responsibility to work together with the physician(s) you select to ensure that all your medical needs are appropriately met, and to notify the appropriate Medical Management Program when pre-authorization is required. (See "Medical Management Programs" for more information.)
Plan physicians and hospitals who participate in the Anthem Blue Cross Prudent Buyer Plan PPO network have agreed to charge members certain negotiated rates. If you receive care from a network provider who charges more than the negotiated rate, you will be held harmless for those charges above the negotiated rate. The same will be true if a Plan network provider has referred you to a non-network provider. You will not be responsible for fees over the Customary and Reasonable Charge.
If you receive treatment from a doctor who does not participate in the Prudent Buyer Plan PPO network, you may be responsible for any amounts over the Customary and Reasonable (Eligible Expense) limits. These amounts can be substantial. You should discuss this with your physician.