Providers - Program 3 Plus

Care Providers

Description

Participating (Blue Cross/Blue Shield)--These providers participate with a Blue Cross and Blue Shield Plan.

Nonparticipating--These providers do not participate with a Blue Cross and Blue Shield Plan.

Provider

Participating (Blue Cross/Blue Shield)--Blue Cross and Blue Shield has contracts with these providers and they agree to accept payment arrangements.

Nonparticipating--Blue Cross and Blue Shield does not have contracts with these providers and they do not agree to accept payment arrangements.

Advantages

Participating (Blue Cross/Blue Shield)--These providers file claims for you.

Nonparticipating--These providers are not responsible for filing claims for you. You may have to file you own claims.

Disadvantages

Participating (Blue Cross/Blue Shield)--Claims are settled directly with these providers.

Nonparticipating--Claims are settled with you, not these providers.

Participating Providers. All hospitals in Iowa are participating providers and over 4,000 physicians in Iowa are also participating providers.

Emergency Services. If you receive emergency care for covered services and cannot reasonably reach a participating provider, emergency care received during the course of the emergency will be reimbursed as though the services were received from a participating provider. 

Providers at The University of Iowa Hospitals and Clinics

When care is provided at The University of Iowa Hospitals and Clinics, the individual and the provider will agree on the role residents will play in the individual's care.  An individual may choose to have all primary health care provided by faculty members.  When an individual is hospitalized, residents and medical students are an integral part of the staff which provides support for treatment by the faculty.

Health Care for Individuals Who Are Away from Iowa

Out-of State . If you are in a state other than Iowa and require medical care, you may call Wellmark Blue Cross and Blue Shield of Iowa for assistance in locating the closest participating provider in that state. For covered services received in a state other than Iowa there are advantages in using providers who participate with the Blue Cross and Blue Shield Plan in that state.

Out-of-Country. If it is necessary to receive covered services in a country other than the United States, it is advisable to contact Blue Cross and Blue Shield for assistance in locating the closest participating provider in that country.