As a Blue Cross and Blue Shield of Illinois member, you have access to a large network of providers. To help ensure that you get the highest level of benefits when getting care from certain types of providers, please keep the following things in mind.
Independent Clinical Laboratories
If you are receiving laboratory work at your provider's office, there may be separate charges for this work. One charge may be made by your provider's office for collecting a sample (for example, a blood sample), and another charge from the laboratory for the actual testing and analysis of the sample.
To avoid any out-of-network charges for the laboratory work, ask your doctor about the laboratory he or she uses so that you can verify that the laboratory is in your network.
Due to the number of specialties that fall under "independent laboratory services," you may want to search for these specialties when checking on the network status of a particular laboratory:
Durable and Home Medical Equipment (DME) Suppliers
If you use durable medical equipment (DME) in your home, please note that we determine whether a DME provider is in network based on the state where the purchase was made, not the state the provider is in. For example, if you live in Illinois and purchase equipment via mail order from a supplier in Florida, you need to make sure that the provider is in network for Blue Cross and Blue Shield of Illinois. If you shop in person at a retail store in Wisconsin, check that the provider is in network for Wisconsin.
DME providers may also be included under "pharmacy/DME supplier."
If you receive specialty pharmacy drugs (for non-routine, biological therapeutics that generally includes injectables and infusion therapies, high-cost therapies and therapies that require complex care) at your provider's office or through the mail, be sure to check the pharmacy's network status. In this case, network status is determined not by your location or the location of the pharmacy, but by the location of the ordering physician (usually your doctor).
Specialty pharmacies may also be included under "pharmacist" or "pharmacy/DME supplier."
If you have any questions or want to confirm whether a provider meets these network criteria, please call Customer Service at the number on the back of your member ID card.
Blue Cross Community MMAI(Medicare-Medicaid Plan) is provided by Health Care Service Corporation, a Mutual Legal Reserve Company9HCSC), an independent lisence of the Blue Cross and Blue Shield Association. HCSC is a health plan that contracts with both Medicare and Illinois Medicaid to provide benefits of both programs to enrollee. Enrollment in HCSC's plan depends on contract renewal.
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