Fact Sheet: Select Blue Limited Network - Blue Cross Blue Shield of ...

Select Blue ®
Limited Network
Fact Sheet
Overview of the Select Blue network
This limited network, offered by our subsidiary Blue Benefit Administrators (BBA),
provides members with a more selective network of designated PPO-participating
providers, including cost-effective hospitals, affiliated doctors, and other health care
providers, to deliver lower health care costs.
Select Blue highlights
Members are encouraged to seek care from an innetwork
provider whenever possible.
Referrals are not required.
Emergency care is covered.
Available to self-insured, municipal employers who
can choose PPO and EPO benefit plans with the Select
Blue network.
• EPO members do not have out-of-network
benefits within Massachusetts.
• The BlueCard ® Network is available for care
outside of Massachusetts
Members may have pharmacy benefits, depending on
their employer (check the ID card for the name of the
pharmacy benefit administrator).
When to contact BBA
For eligibility and benefits, claim, reimbursement, or
authorization inquiries, contact BBA:
Online at bluebenefitma.com
By phone at 1-877-707-2583
Sample ID card for Select Blue members.
Submit claims to BBA
Electronic:
Through a clearinghouse, use electronic payer
ID 03036
Mail:
Blue Benefit Administrators of MA
P.O. Box 55917
Boston, MA 02215-3326
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Select Blue ®
Limited Network
Fact Sheet
Reimbursement for services
For services:
Select Blue Exclusive Provider
Organization (EPO) Plans:
Select Blue PPO Plans:
Performed by a
participating
Select Blue innetwork
provider
Reimbursement is paid at PPO
contracted rates.
Reimbursement is paid at PPO contracted
rates.
Performed by a
participating
Select Blue outof-network
provider
Plan approval is required for any outof-network
service, unless the
member requires emergent or urgent
care.
Reimbursement for an approved,
out-of-network service or emergent
and urgent care will be paid directly to
the provider at PPO contracted rates.
Members are responsible for their
cost sharing and may not be balance
billed.
Reimbursement for out-of-network
services, including urgent and emergent
services, will be paid directly to the
provider at PPO contracted rates.
Members are responsible for their cost
sharing and may not be balance billed.
Members can use their out-of-network
benefits; however, as with our other PPO
plans, the member will incur a higher costshare
for out-of-network services.
Performed by a
nonparticipating
provider
Plan approval is required unless the
member requires emergent or urgent
care.
o Reimbursement for a preapproved
service performed
by a non-participating
provider will be paid directly
to the provider.
In emergent or urgent situations,
reimbursement is paid directly to the
subscriber who will be responsible for
reimbursing the provider.
If a member is admitted to a nonparticipating
hospital for emergent or
urgent care, we may request that the
member be transferred to an innetwork
hospital for care, once
stabilized.
Members can use their out-of-network
benefits; however, the member will incur a
higher cost-share for out-of-network
services performed by a non-participating
provider.
Reimbursement for any services
performed by a non-participating provider
will be paid directly to the subscriber, who
will be responsible for reimbursing the
provider. A usual and customary fee
schedule may apply. Members may be
balance billed (in addition to their cost
share for the service).
Find a Doctor directory
Providers and members can use BBA’s website, bluebenefitma.com, to find a doctor or other health care
provider.
Other resources
For a BBA handbook with additional details about policies and procedures for providing care to members
when BBA is the administrator, log on to bluecrossma.com/provider and select Resource
Center>Admin Guidelines & Info. The BBA handbook is in the appendix of the Blue Book.
® Registered Marks of the Blue Cross and Blue Shield Association. ©2013 Blue Benefit Administrators of Massachusetts
PEP-3976J (6/13)
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