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FAQ

Traditional Blue Cross^® and Blue Shield^® Plans

What is Traditional Indemnity coverage?

Can I go to any hospital or doctor?

Am I covered for services if I travel out of the state?

Will I owe my doctor the balance on a bill?

What is Traditional Indemnity coverage?
Traditional insurance provides you with the most freedom of choice and offers you the most control over your health care. Traditional insurance, also known as indemnity or fee-for-service, allows you to select any provider, however, benefits are maximized when using a Blue Cross^® or Blue Shield^® participating provider.

Insurers often set the amount they will pay for a particular service at a usual, customary, and reasonable (UCR) fee (non-group options also include medical/surgical plans based upon a fee schedule). Participating professional providers agree to accept the UCR fee as full payment for each service provided (within policy limits). If you do not use a participating professional provider, you may be responsible for the difference between the UCR fee and the provider’s charge.

Those with traditional coverage may also be subject to deductibles and coinsurance, even when using the plan’s participating providers. In addition, traditional coverage does not typically cover routine preventive services that are usually covered by most managed care plans.

Can I go to any hospital or doctor?
Yes, you have the freedom to choose any hospital or doctor. If the hospital or doctor participates, your plan pays them according to your contract minus any deductibles or coinsurance for inpatient or outpatient care. If the providers do not participate with any Blue Cross or Blue Shield plan, you will receive non-participating provider benefits according to your contract.

Am I covered for services if I travel out of the state?
If the provider is a participating provider with their local Blue Cross and Blue Shield plan, Independence Blue Cross will allow member benefits subject to any deductibles or copayments. If the provider does not participate with their local Blue Cross and Blue Shield plan, you will receive non-participating provider benefits according to your contract.

Will I owe my doctor the balance on a bill?
Under Blue Shield Plan UCR 100, participating doctors will accept Blue Shield payment as payment in full and will not bill you for a balance.

If you have one of the fixed fee schedules such as Plan 5000S, Plan C, or Plan 1800S and you fall within the income limits of that plan, the doctor will accept Blue Shield’s payment as payment in full and will not bill you for a balance.

In the case of a non-participating provider (one that does not participate with Highmark Blue Shield), all balances are the responsibility of the patient.