Out-of-network services

As part of your care, your doctor may order medical equipment and clinical lab and specialty pharmacy services. You may want to get these from a participating, or in-network, provider to save money.

If you get medical services from a non-participating provider, eligible medical products and services will be processed at a higher, out-of-network rate.

When is a service in-network or out-of-network?

Independent clinical lab (ICL)

ICL services, including blood tests and urine analysis, may be offered by any laboratory not in a hospital. In-network ICL providers should participate or be in-network in a Blue Plan in the state where your specimen is drawn. This location is determined by the physical location of the referring provider.

Durable / Home Medical Equipment (D/HME)

With D/HME services, medical equipment is rented or bought from a retail store, or ordered and shipped to your home:

Hospital beds
Crutches
Wheelchairs
Oxygen tanks
Respiratory therapy machines

In-network D/HME providers should participate in a Blue Plan in the state the equipment is shipped to, or the location of the store if it’s purchased at a retail location.

Specialty pharmacy services

In-network specialty pharmacies should participate in a Blue Plan in the state where the ordering physician is located. Services include:

Injectables and infusion therapies
High-cost therapies
Complex care therapies