Under this indemnity prefix, the member has fee-for-service coverage. There is no provider network, no referral requirement, and no primary care physician gatekeeper. Claims are processed based on the plan's fee schedule. While less common than managed care plans, indemnity coverage is still offered by some BCBS companies.
Under this prefix, the member may have Medicaid coverage managed by this BCBS plan. Medicaid claims have specific rules around cost-sharing, balance billing, and timely filing that override the plan's standard commercial policies. Contact the plan's Medicaid provider services line for submission details.
PPO coverage under this prefix means the member can access any provider. In-network providers have negotiated rates with the plan, while out-of-network providers are reimbursed based on usual and customary charges. Prior authorization is generally not required for routine services but may be needed for high-cost procedures.
Independent licensee providing commercial, Medicare and Medicaid plans to Ohio members.