Participating Provider
Physicians and Other Medical Professionals
Participating Providers (physicians and other medical professionals, such as physical therapists, nurse practitioners, etc.) have contracted with BCBSMT to provide services.

Participating Providers accept the BCBSMT allowable fee plus any deductible as payment in full for covered services. These providers will submit your claim for you, and BCBSMT will pay the Participating Provider directly.

Finding Participating Providers
A majority of health care providers in Montana are Participating Providers. To find the participation status of a provider, check our on-line provider directory at www.bcbsmt.com, or contact Customer Service at 1-800-447-7828. Be sure to have your subscriber identification number available when you call.

Non-Participating Provider
Physicians and Other Medical Professionals

Non-Participating providers (physicians and other medical professionals, such as physical therapists, nurse practitioners, etc.) have not contracted with BCBSMT, and your out of pocket expenses can be significantly higher.

Non-Participating providers are subject to a 20% differential which means BCBSMT reduces its allowable fee by 20% before calculating your benefits. You may be balance billed by the Non-Participating provider for the difference between the BCBSMT payment and the total charge including any deductible and coinsurance amounts.

Blue Card Out-of-State and World-Wide Health Care Services
The BlueCard Program enables BCBSMT members who are traveling or living in another Blue Plan’s service area to receive all the same benefits of their BCBSMT Plan and access to BlueCard providers and savings.  If you choose a Participating Provider in another state for health care services, these providers will file claims for you.  There may be no balance billing except for your deductible.

To find BlueCard Participating Providers, call 1-800-810-BLUE (2583) or visit our website at www.bcbs.com/healthtravel/.

Benefit

Covered Services

Professional Provider Services

Home and office calls, surgery, anesthesia, diagnostic lab and x-ray and other services provided by a Professional Provider.

Room and board, special care units, ancillary charges and
transplant coverage.

Accidental injury, x-ray and lab, surgery, chemotherapy, respiratory therapy, radiation therapy, medical emergency, surgicenter, oxygen and equipment for use in the home, blood transfusion services, ambulance, medical supplies for use outside hospital, orthopedic devices.

Physical, occupational, speech and cardiac rehabilitation therapies. $2,000 maximum per benefit period, combined for outpatient professional and facility charges.

$100,000 lifetime maximum, per member, combined for inpatient and outpatient rehabilitation therapy services.

Not Covered.

Initial purchase, replacements and repair. Prior authorization is recommended if charges are over $500.

Outpatient

Inpatient

Note: Severe Mental Illness is processed under regular medical benefits.

$2,000 maximum per benefit period.

21 days for professional, hospital and/or freestanding inpatient facility charges, per year combined with chemical dependency. Inpatient day maximum applies. Plan notification is recommended.

$1,000 per benefit period for outpatient services. 21 days for professional and/or freestanding inpatient facility charges, per member, per benefit period combined with Mental Illness.  $4,000 maximum benefit per 24-month period.  $8,000 lifetime maximum benefit.

Well-child exams, lab tests and immunizations through seven years of age.
Deductible does not apply.

Paid at 100% the actual charge or $70, whichever is less.
Deductible applies to any balance after the first $70 is paid.

Up to $250 per benefit period for outpatient services.

Purchase at pharmacy and submit receipts to BCBSMt for processing.

Dues Schedule for HDHP Montana
New and Renewal Rates for July, August and September 2008

New West Health Services     Fortis Health Insurance