Providers - UIChoice

Providers

Care Providers

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 of Provider Levels for UIChoice
Description Providers from University of Iowa Hospitals and Clinics, Carver College of Medicine (CCOM) and UI Community Medical Services Clinics (CMSC), Pediatric Associates of the University of Iowa Children's Hospital (PAUICH), UI Health Alliance Facilities and Primary Care Clinics. 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 Providers.  These providers accept Blue Cross and Blue Shield payment arrangements.  All hospitals in Iowa are participating providers and over 4,000 physicians in Iowa are also participating providers.

When you are out-of-state, participating Blue Cross and Blue Shield providers will result in lower out-of-pocket costs for you.  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.  Balance billing is the practice of billing a patient for the fee amount remaining after the insurer payment and patient co-payment have been made.

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 $50 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.