Publication Date

Publication Date: 

In our ongoing efforts to lower medical expenses for our customers, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) will be implementing an out-of-network lab fee schedule as of July 15, 2015.

The new out-of-network lab fee schedule will apply to all Blue Cross NC commercial business, both individual and group, as well as for our ASO group business, the State Health Plan, the Federal Employee Program, and BlueCard®. It will not apply to our Blue MedicareSM products.

It’s important to remember that all Blue Cross NC participating providers have a contractual obligation to refer Blue Cross NC members to other in-network providers for services, including labs. If you use out-of-network labs (or any other out-of-network provider), this is a violation of your agreement with Blue Cross NC and could result in termination from our networks. Please refer to your Blue Cross NC provider participation agreement for details if needed.

Out-of-Network Services = Higher Out-of-Pocket Expenses for Your Patients

If your practice currently uses a lab that is not in the Blue Cross NC provider network, or if you refer Blue Cross NC patients to an out-of-network lab, you also need to consider how this results in higher health care costs for your patients/our members.

The following table shows how much more your Blue Cross NC patients may have to pay when you use an independent, out-of-network lab:



In-Network Lab

In-Network Hospital Lab

Out-of-Network Lab

Cost of lab test




Member copayment percentage




Member pays





It is imperative that participating providers use or refer to in-network labs, not only to avoid breaching your provider agreement with Blue Cross NC, but to help your Blue Cross NC patients get the most out of their in-network benefits.

To confirm if a laboratory is participating with Blue Cross NC, you can access the “Find a Doctor or Facility” tool, which is available online at Please contact the Provider Blue LineSM at 1.800.214.4844 if you need assistance