BCBS Pays 100% Medicare Allowable For Non-Network Providers


What is Blue Cross’ allowed amount for nonparticipating providers? For physicians, clinics, Ambulatory Surgery Centers (ASC) services, and/or facility services by nonparticipating providers, with some exceptions, the allowed amount for most plans is 100% of the Medicare Allowed Charge that is published at the United States website for Centers for Medicare and Medicaid Services (CMS): http://www.cms.gov/ ExternalLink .”

If Blue Cross pays 100% of Medicare allowable for non-network providers, what do they pay for network providers? Do they pay more, or less? Clue – http://blog.riskmanagers.us/?p=13247


Editor’s Note: From all indications, the BUCA’s pay out-of-network providers anywhere from 100% – 105% of Medicare allowable.