AMBULATORY SURGERY & IMAGING
Your benefit plan offers an unprecedented savings opportunity. Your plan covers seven procedures at 1 00%, with a zero out of pocket cost to you, after your $500.00 copay when any of the procedures outlined below are performed in a free-standing Ambulatory Surgical Center (ASC) or Imaging Facility. These are BlueCross BlueShield in-network facility not associated with a hospital.
See an example of the potential savings below:
SAMPLE COMPARISION Total Knee Replacement
Place of Service
Free Standing ASC or Imaging Facility
Outpatient Hospital
Expenses
$500 Copay
$1,000 Deductible $2,250 Coinsurance
Total Member Responsibility $3,250 *Savings are based on the cost of the procedure, applicable deductible and coinsurance at the time the service is rendered. $500
Procedures covered at 100% after copay include: Rotator Cuff Surgery
Total Knee Replacement
Total Hip Replacement
MRI
Spinal Fusion
Hernia Surgery
CT Scan
Frequently Asked Questions (FAQ) How do I know if my facility is an in-network free standing facility? Check with the facility prior to any procedure to ensure they are still in-network and are contracted as a free-standing facility. How do I know how much I will be charged for my MRI/CT Scan? It is recommended that you contact the provider prior to your appointment to confirm how it will be billed. Imaging services can be billed in the following ways. If you need additional assistance verifying how a facility bills a specific service, please contact the BlueCross BlueShield .
If the provider files as an office visit (some may and some may not); then the $45 copay will apply.
If the provider files as outpatient hospital, then deductible and coinsurance will apply.
If the provider files as outpatient at a free standing facility; a $500 copay will apply.
Is there anything additional I need to do to take advantage of this benefit? No. Insurance will automatically process any qualifying services as a $500 copay. How do know if my doctor can perform my surgery at an Ambulatory Surgery Center? It is important to discuss with your doctor where you intend to have your surgery. Your doctor will be able to tell you if he/she can perform the surgery or possibly refer you to someone who can.
CONMB Employee Benefit Guide 2025
6
Made with FlippingBook - professional solution for displaying marketing and sales documents online