Blue Cross Blue Shield of North Carolina, unlike many of the companies offering coverage through the health insurance Marketplace, provides plans that cover you both in-network as well as out-of-network.  Having out-of-network coverage when it counts can make an enormous difference in your out-of-pocket expenses.  It’s important, however, to find out ahead of time whenever possible whether or not your provider is in network with your plan.  Because you will pay more for out-of-network coverage, knowing which doctors and hospitals accept your plan is one of the best ways you can manage your health care costs. (more…)

The terms “in -network” and “out-of-network” are terms you may have heard in relation to health insurance, but understanding the implications of these terms is of utmost importance as you select, enroll and manage your Blue Cross Blue Shield of NC health plan.  In fact, understanding your network and how it works can have a big impact on the cost of your health care and a little research can save you a lot of money.

The first thing to understand is that Blue Cross Blue Shield of North Carolina is not an HMO, meaning you are not required to stay within your network in order to have coverage.  This is good news in that it allows you more freedom and flexibility, as well as covering you in case you have an out-of-network provider you either prefer to use or must use for your medical needs.  The benefit of both in-network and out-of-network coverage is not something every health insurance company offers, which is one of the reasons BCBSNC is a recognized leader among health insurance providers and the only company with a presence in all 100 counties within the state of North Carolina.

That being said, it is still in your best financial interest to stay in-network. In fact, the difference between “in-network” coverage and “out-of-network” coverage can sometimes be the difference between a small co-payment and having an office visit that is subject to your medical deductible.  That is why understanding your network is so important.

Basically, BCBSNC has four different networks available:  Blue Advantage, Blue Select, Blue Value and Blue Local.  The broadest of these networks is the Blue Advantage and over 95% of doctors and hospitals in the state are a part of the Advantage network.  If you can afford it, this is always the network we would recommend as it offers you the most amount of choices when it comes to in-network providers.  Blue Select is a tiered network and though also a broad network, it will require a little more management in that some of the providers are Tier 1 providers and some are Tier 2 providers and there is a difference in the cost of these two tiers.  If you choose to go with a Blue Select plan, just keep in mind that you will need to research the tiers and providers therein prior to selecting a doctor or hospital.

Blue Value is a more limited network than either Blue Advantage or Blue Select.  In fact, the Blue Value network is not even offered in some areas simply because there are not enough participating providers to warrant that option.  However, in some instances and if your doctors and hospitals are a part of this network, choosing a Blue Value plan can be a smart way to save money as the monthly premiums are lower.  Keep in mind, however, that this is where doing your research becomes necessary.  If you have a particular doctor or specialist you must see, you may want to call his or her office and verify that they are a part of the Blue Value network and accept that plan.  Less expensive can be good, but only if you are satisfied with your choice of providers and have ample doctors and hospitals to choose from in your area.  You can always use the BCBSNC Find a Doctor tool to research providers.

Finally, Blue Local is the most limited of the four BCBSNC networks.  This is a new network with Carolinas HealthCare System and is only available in nine counties in North Carolina.  Again, this network will be less expensive, but also more exclusive.  If you do not intend to stay within the Carolinas HealthCare System, this is not the network for you as you will wind up paying out-of-network prices.

The main thing to remember is that a small amount of research can save you big bucks in the long run.  Taking a few minutes to call your doctors to determine which plans they accept and which networks they are a part of can make a drastic difference in your overall out of pocket healthcare expenses.  Blue Cross Blue Shield of NC is committed to providing a broad range of coverage at a variety of price points, allowing you to determine which networks and which plans work best for both your family and your finances.

For more information on Blue Cross Blue Shield of North Carolina health insurance coverage, the Marketplace and healthcare gov  to apply for your subsidy, please visit our website at www.nchealthplans.com or call our toll free number 888-765-5400 and speak with one of our experienced and professional agents.  Let us help you navigate through the Health Care Reform changes in accordance with the new regulations of The Affordable Care Act, also known as Obama care.

Blue Cross Blue Shield of NC offers several network options when selecting your health insurance plan to allow you the flexibility to choose the coverage that bests suits your needs.  It is important to understand these networks before making your final plan selection.

To gain access to the best and largest network of doctors and hospitals, go with a Blue Advantage plan.  Blue Advantage offers you a broad choice of doctors, specialists and hospitals with the largest network available that includes 91% of doctors and 99% hospitals.

Does having the option to save money by selecting a doctor from two tiers of in-network providers appeal to you? Blue Select plans offer you this opportunity. With Blue Select, BCBSNC has tiered benefits and providers to help you make the most of your health care spending. BCBSNC has evaluated doctors and specialist physician practices on their quality outcomes, cost efficiency, and accessibility and created two categories:

Tier 1 are providers who received top ratings, and you’ll receive a richer benefit when you choose these providers.

Tier 2 are providers who still meet the usual standards for being part of the network, and you’ll receive a less rich benefit when you choose these providers. By tiering the benefits and providers, you’ll save up to 6% on your monthly premium and have a clear way to save more money by choosing Tier 1 providers. You can see which tier your providers are in by visiting the Find a Doctor tool.

Is having a plan with a lower premium more important to you than having the largest network of doctors and hospitals available? If so, a Blue Value plan might work for you. Blue Value features a limited network of providers and some of the lowest costs of all the plans.  Blue Value can offer up to 9% savings, but has a limited network of doctors, hospitals, and pharmacies to lower costs. (Blue Value may not be available in all areas.)

For more information on health insurance coverage in North Carolina, please visit our website at www.nchealthplans.com or call our toll free number 888-765-5400 and speak with one of our professional agents. Our agency provides coverage for health insurance in North Carolina through Blue Cross Blue Shield of North Carolina (BCBSNC). It would be our pleasure to help you navigate through the Health Care Reform changes in accordance with the new regulations of Obama care. Call us for details.