Question

Mrs. Thomas was on vacation out of state when she stepped off a curve and injured her left ankle. Due to severe pain she was seen at an urgent care center where she underwent a left ankle x-ray, which was negative. She was diagnosed with a left sprained ankle. A walking boot was provided to stabilize and protect her left ankle. She was provided with appropriate discharge instructions and instructed to follow up with her primary care physician upon returning home. When she presented her BlueCross BlueShield insurance card at check out, Mrs. Thomas was informed that the physician who provided treatment is a nonparticipating provider (nonPAR) and that the urgent care center accepts credit cards for payment in full. The total due was $1,500, and Mrs. Thomas assured the office staff that her insurance company would reimburse the urgent care center for services provided. The office staff further explained that their providers had not signed a contract with her insurance, and thus Mrs. Thomas was required to settle the bill upon discharge. The office staff suggested that her Blue Cross/Blue Shield insurance plan might reimburse Mrs. Thomas for the urgent care center encounter and that she would need to submit the invoice and claim to her insurance company. What are the requirements of a BCBS participating provider (PAR)?

Answer 1

BlueCross BlueShield (BCBS) participating providers, also known as PAR providers, are health care providers who have signed a contract with BCBS to provide services to BCBS members. This means that they agree to accept the reimbursement rates and terms specified in the contract with BCBS, and BCBS members will typically pay less out-of-pocket for services received from PAR providers. Non-PAR providers, on the other hand, have not signed a contract with BCBS and may not be required to accept the same reimbursement rates and terms. As a result, BCBS members may have to pay more out-of-pocket for services received from non-PAR providers. It is important for BCBS members to check with their insurance plan to determine which providers are PAR and which are non-PAR, as this can affect their out-of-pocket costs for services received.