Summary of Your Costs. For providers of medical care, we use four terms.
Summary of Your Costs. Out-Of-Network Providers are providers that are not in your provider network. If the provider is a contracted provider they will not bill you the amount above the allowed amount for a covered service. If the provider is a non-contracted provider they will bill you the amount over the allowed amount for a covered service. See the
Summary of Your Costs. Non-Contracted Providers are providers that do not have a contract with us. If a service provided by a non- contracted provider is covered, the provider will bill you the amount above the allowed amount for a covered service. See the
Summary of Your Costs. 5. Do I have to use certain pharmacies to pay the least out of my own pocket under this plan? Yes. You only receive benefits when you have your prescriptions filled by participating pharmacies. The majority of pharmacies in Washington are part of our pharmacy network. Also, specialty drugs are only covered when dispensed by our designated specialty pharmacies. See “Specialty Pharmacy Program” earlier in this benefit. You can find a participating pharmacy near you by consulting your provider directory, or calling the Pharmacy Locator Line at the toll-free telephone number found on the back of your Premera ID card.
Summary of Your Costs. You can get a complete list of the preventive care services with these limits on our website at xxxxxxx.xxx or call us for a list. This list may change as required by state and federal preventive guidelines change. The list will include website addresses where you can see current federal preventive guidelines. Private Duty Nursing Benefits are not provided for private duty or 24-hour nursing care. See Home Health Care for home nursing care benefits. Provider's License or Certification This plan does not cover services that the provider's license or certification does not allow him or her perform. It also does not cover a provider that does not have the license or certification that the state requires.
Summary of Your Costs. Contracted Providers are providers that have a contract with us. These providers may or may not be in your provider network. If a service provided by an out-of-network contracted provider is covered, the provider will not bill you the amount above the allowed amount for a covered service. See the
Summary of Your Costs. Out-Of-Network Providers are providers that are not in your provider network. An out-of-network dental provider will bill you the amount over the allowed amount for a covered service. See the
Summary of Your Costs. Oral chemotherapy drugs • Drugs associated with an emergency medical condition (including drugs from a foreign country)
Summary of Your Costs. Sometimes a drug maker’s packaging may affect the supply in some other way. We will cover a supply greater than normally allowed under your plan if the packaging does not allow a lesser amount. Exceptions to this limit may be allowed as required by law. For example a pharmacist can authorize an early refill of a prescription for topical ophthalmic products in certain circumstances. You must pay a copayment for each limited days’ supply.
Summary of Your Costs. If you do not show your Premera ID Card, you will be charged the full retail cost. Then you must send us your claim for reimbursement. Reimbursement is based on the allowed amount. See Sending Us a Claim for instructions. This plan does not cover prescription drugs from out- of-network pharmacies.
