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Q: If I go to a BCBS PPO Network hospital and the doctor or other healthcare professional that treats me is a non-BCBS PPO Network provider, will benefits for those professional services be subject to out-of-network benefit levels?

A. Certain inpatient and outpatient hospital services are covered at in-network benefit levels, despite the provider's non-participation in the BCBS PPO Network. The below services are characterized by the fact that the patient has little or no control over which provider performs the service:

•  Ambulance
•  Anesthesiology
•  Radiation Therapy
•  Radiology
•  Laboratory
•  Pathology
•  Emergency Room Physician
•  Nuclear Medicine

We remind you, however, that if the provider does not participate in the BCBS PPO, BCBS Traditional, or MultiPlan Network, the patient will be subject to balance billing for charges in excess of MCTWF's maximum allowable benefit (MAB) schedule.

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