Blue Choice Network
- National Provider Locator (outside of Iowa and South Dakota)
Select BlueCard Traditional from the Choose Your Network Dropdown menu.
- BC International Provider Locator
- The University Health Care Alliance (UIHA) and other designated providers are considered UIChoice Level 1 providers for 2019.
|Provider Category||Level 1 Providers||Level 2 Providers||Level 3 Providers (PARTICIPATING Blue Cross/Blue Shield)||Level 3 Providers (NON-PARTICIPATING Blue Cross/Blue Shield)|
|Description||Providers from University of Iowa Hospitals and Clinics, UI QuickCare, UI Urgent Care Clinic, Carver College of Medicine (CCOM) and UI Community Medical Services Clinics (CMSC), Pediatric Associates of University of Iowa Stead Family Children's Hospital, UI Health Alliance Facilities and Primary Care Clinics and other designated providers.||Blue Choice network providers not included in Level 1||These providers participate with a Blue Cross and Blue Shield Plan not in Level 1 or 2.||These providers do not participate with a Blue Cross and Blue Shield Plan and are not in Level 1 or 2.|
|Provider||Blue Cross and Blue Shield has contracts with these providers and they agree to accept payment arrangements.||Blue Cross and Blue Shield has contracts with these providers and they agree to accept payment arrangements.||Blue Cross and Blue Shield has contracts with these providers and they agree to accept payment arrangements.||Blue Cross and Blue Shield does not have contracts with these providers and they do not agree to accept payment arrangements.|
|Claim Settlement||These providers file claims for you.Claims are settled directly with these providers.||These providers file claims for you.Claims are settled directly with these providers.||These providers file claims for you.Claims are settled directly with these providers.||These providers are not responsible for filing claims for you. You may have to file your own claims.Claims are settled with you, not these providers.|
Participating vs. Non-Participating Providers
In Iowa, participating providers will accept payment arrangements and file claims for you with Blue Cross and Blue Shield. Payment is made directly to these providers.
Non-participating providers do not have contracts with Blue Cross and Blue Shield. They do not agree to accept payment arrangements and are not responsible for filing claims for you. Non-participating providers may charge more for health care than participating providers. Payment is made to you and you are responsible for paying the provider. Non-participating providers can bill you for the difference between what Blue Cross and Blue Shield will pay for a service and what they charge (balance billing).
When you are out-of-state, participating Blue Cross and Blue Shield providers will result in lower out-of-pocket costs for you and the out of pocket maximum for Levels 1 and 2 will apply to these providers. If it is a state that allows balance billing, using a participating Blue Cross and Blue Shield provider should result in a lower balance bill.
Emergency Services. If you receive emergency care for covered services and cannot reasonably reach a participating provider, emergency room care received during the course of the emergency will be reimbursed as though the services were received from a participating provider. You will have a $100 co-payment which will be waived if you are admitted.
An emergency can be considered to be a medical condition that a prudent layperson (with an average knowledge of health and medicine) could reasonably expect to result in serious jeopardy to a person’s health in the absence of immediate medical attention. The emergency services must be provided in an emergency room setting (not an urgent care center or physician’s office).
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 at (800) 810-BLUE (2583) for assistance in locating the closest participating provider in that state. You can also find providers in other states through the Wellmark website. For covered services received in a state other than Iowa there are advantages to 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.
ABOUT OUR SITE:
The information presented on our website describes only the highlights of the plans and does not constitute official plan documents. Additional terms and conditions may apply. If there are any discrepancies between the information contained herein and the official plan documents, the plan documents will govern. For more detailed information you may contact Wellmark Blue Cross/Blue Shield at toll-free number 800-524-9242 (TTY: 888-781-4262), Monday through Friday from 7:30 a.m. to 5:00 p.m. (Central Time). For more efficient service, please have your member ID number handy - it can be found on the front of your card.