In-network specialty care for Alaska caregivers
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.