In the course of your overall medical care, your provider may request additional or ancillary services including, clinical lab services, medical equipment and specialty pharmacy services.
Making sure all your providers are in-network can save you money. If you receive services from a non-participating provider, eligible services will be processed at the out-of-network benefit rate.
How to Determine if a Service will be Considered In- or Out-of-Network
Independent Clinical Lab (ICL)
Services are provided by any non-hospital-based laboratory and generally include, but are not limited to, blood tests, urine analysis, etc. In-network ICL providers should participate in the Blue Plan in the state in which the specimen is drawn. The location of where the specimen was drawn is determined by the physical location of the referring provider.
Durable/Home Medical Equipment (D/HME)
Services include, but are not limited to: medical equipment, such as hospital beds, crutches, wheelchairs, oxygen tanks or respiratory therapy machines that are rented or purchased from a retail store, or ordered and shipped to your home. In-network D/HME providers should participate in the Blue Plan in the state the equipment is shipped to, or the location of the store if it is purchased at a retail location.
Specialty Pharmacy Services
Include injectables and infusion therapies, and high-cost and complex care therapies. In-network specialty pharmacies should participate in the Blue Plan in the state where the ordering physician is located.