There are certain specialties in Alaska where there may not be enough contracted physicians in the Premera Blue Cross network to meet members’ needs. As a result, for certain specialties provided in Alaska by an out-of-network physician (i.e. physician not contracted with Premera), the claim can be processed at the in-network (tier II) level. Any charges, however, submitted by the out-of-network physician exceeding usual & customary as determined by the plan will not be allowed. The provider may choose to write-off the charges above the allowed amount. If the physician's office does not, the member may be subject to "balance billing" – the difference between the billed amount and the usual & customary, allowed amount.
Please contact Providence Health Plan customer service at 800-878-4445 if you need to confirm whether a specific out-of-network physician in Alaska is impacted by this network provision.