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Q: If my BCBS PPO Network physician tells me that I need a specialist, but there are no specialists to treat my condition located in my geographic area, can I get a referral to a non-BCBS PPO Network physician and get the same benefits?

A: Yes. In the event that a particular service or specialty is not available in the BCBS PPO Network, your BCBS PPO Network provider may refer you outside the BCBS PPO Network. Your provider must complete a referral form and the non-BCBS PPO Network provider must submit the referral with the claim to ensure coverage at in-network benefits levels. If the provider does not participate in the BCBS Traditional Network or MultiPlan Network, you will be subject to balance billing for charges in excess of MCTWF's maximum allowable benefit (MAB) schedule.

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