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Members continue to receive choice of health care providers

added April 7, 2011

Beginning at plan anniversaries on or after Sept. 23, 2010, all non-grandfathered health plans must offer new protections assuring that consumers can choose the primary care provider or pediatrician of their choice from their plan's provider network. In addition, consumers can visit an OB-GYN without needing a referral.

Other new consumer protections for non-grandfathered health plans concern use of emergency rooms. Consumers will not be required to obtain prior approval when seeking emergency care at a hospital outside of the plan's network.

Also, a health insurer must apply the same cost-sharing requirements (deductible, copayments and coinsurance) for emergency services received out-of-network as it does in-network.

For the most part, Blue Cross and Blue Shield of Kansas members already enjoy these protections as they are able to receive services from any member of the company’s contracting network. For 2011, the Blue Cross and Blue Shield of Kansas network is comprised of 96 percent of all providers in its service area, including 99 percent of all medical doctors and medical facilities.

In the event of an emergency, whether you are at home or away from home, Blue Cross always recommends that you to go to the nearest available acute care facility.