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Out-of-network services

  

As part of your care, your doctor may order medical equipment and clinical lab and specialty pharmacy services. You may want to get these from a participating, or in-network, provider to save money.

If you get medical services from a non-participating provider, eligible medical products and services will be processed at a higher, out-of-network rate.

When is a service in-network or out-of-network?

Independent clinical lab (ICL)

ICL services, including blood tests and urine analysis, may be offered by any laboratory not in a hospital. In-network ICL providers should participate or be in-network in a Blue Plan in the state where your specimen is drawn. This location is determined by the physical location of the referring provider.

Durable / Home Medical Equipment (D/HME)

With D/HME services, medical equipment is rented or bought from a retail store, or ordered and shipped to your home:

  • Hospital beds
  • Crutches
  • Wheelchairs
  • Oxygen tanks
  • Respiratory therapy machines

In-network D/HME providers should participate in a Blue Plan in the state the equipment is shipped to, or the location of the store if it’s purchased at a retail location.

Specialty pharmacy services

In-network specialty pharmacies should participate in a Blue Plan in the state where the ordering physician is located. Services include:

  • Injectables and infusion therapies
  • High-cost therapies
  • Complex care therapies

Blue Cross and Blue Shield of North Carolina does not discriminate on the basis of race, color, national origin, sex, age or disability in its health programs and activities. Learn more about our non-discrimination policy and no-cost services available to you.

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