With the PPO Non-Needles Plan, you can receive care from any of the physicians and hospitals within the plan's network, as well as outside of the network for covered services.
Within the provider network
Preventive care services such as a flu shot are fully covered. You pay 100% for all other services until you meet your plan-year deductible. After your deductible is met, you pay a copayment or coinsurance for covered services. PPO Network providers submit their claims directly to Blue Shield, so it's convenient for you.
Going to providers in the PPO Network provides you with the lowest out-of-pocket costs.
Outside the provider network
When you see a non-network provider, what you ultimately pay depends on fees above Blue Shield's allowable amounts. Those fees vary and can be costly. Non-network providers usually require you to pay the full amount at the time you receive care. You then submit a claim with an itemized doctor's bill to Blue Shield.
For more details, visit blueshieldca.com/teamsters1932.