Please be aware that as of January 1, 2009 some PPO plans, including some BCBS-Massachusetts PPO plans, will change their benefit offerings with regard your "out-of-network" coverage. Traditional PPO plans allow for a patient to go "out-of-network" and obtain care from physicians not contracted with the managed care plan of a particular insurer. These plans then cover a percentage of your bill. For example, one plan may cover 80% of your bill, with you, the patient, then being responsible for the 20% balance, or "co-insurance". Some PPO plans from BCBS and other insurers will now pay the out of network physicians a fee based on a "usual and customary" fee rate. This rate or fee schedule is determined by the insurance company. This could mean a much smaller percentage of your bill will be coverage by the insurer, leading to a larger balance or "co-insurance" to be left to you. This may transfer a significant portion of the cost of going out of network from the insurance company to you, despite the higher cost of your PPO policy.
We recommend that you verify the benefits offered by your PPO plan when the policy is renewed.