Our PPO benefit program is made up of PPO hospitals and professional providers that agree to fees set by BCBSIL as the maximum cost for their services.

You must provide services in Illinois or Lake County Indiana in order to apply.

Referrals
Written referrals are not required, but when a referral is necessary, the PPO provider must make every effort to refer the member to in-network PPO providers, hospitals, and other medical facilities for services.

In instances where a referral is made to an out-of-network provider and/or to an entity with whom the Contracting Provider has a business interest, the member must be notified of the same in writing at the time of the referral. Referrals to out-of-network providers could result in reduced benefits for the member.

Reimbursement
Payment for services is according to the PPO Schedule of Maximum Allowances (SMA).

Member Payments
Providers should bill BCBSIL prior to collecting any fees other than copayments from the member. After the claim is adjudicated, providers may bill the member for any deductibles, coinsurance, or non-covered services.

Providers may not balance bill the member for any fees over the allowable charge.

The PPO Professional Networks includes the following eligible provider types: 

• Certified Nurse Midwife (CNM)
• Certified Nurse Practitioner (CNP)
• Certified Registered Nurse Anesthetist (CRNA)
• Certified Surgical Assistant (CSA)
• Certified Surgical Technologist (CST)
• Chiropractor (DO)
• Clinical Psychologist (PhD)
• Durable Medical Equipment (DME Supplier)
• Home Infusion (Therapy Supplier)
• Independent Lab
• Licensed Clinical Nurse Specialist (LCNS)
• Licensed Clinical Professional Counselors (LCPC)
• Licensed Clinical Social Worker (LCSW)
• Licensed Marriage and Family Therapist LMFT)
• Optometrist (OD)
• Orthotic Supplier
• Osteopath (DO)
• Physician (MD)
• Podiatrist (DPM)
• Prosthetic Supplier
• Registered Nurse First Assistant (RNFA)
• Registered Surgical Assistant (RSA)
• Sleep Medicine Centers
• Surgical Assistant Certified (SAC)
• Therapist (Physical-PT, Speech-ST, Occupational-OT)

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