BCBSRI member “Kate" visits her specialist for an office visit. The specialist recommends that she have some lab work, and Kate agrees and proceeds. About a month later, much to her shock, Kate receives a bill from that lab for thousands of dollars, since the lab is outside the BCBSRI network. She’s frustrated and quite frankly angry, because as a BCBSRI member visiting a doctor in the BCBSRI provider network, she assumes that all her care—including labs that her doctors use—is within the network, and therefore at pre-negotiated rates that protect her financially.

Kate talks to a BCBSRI Customer Service rep to investigate the situation, who works with a Physician and Provider Service Center rep, who contacts the doctor, and so on. As you can see, there’s lots of time spent on the issue by multiple people, not to mention frustration and inconvenience for Kate.

In another scenario, BCBSRI member “Dan" visits his specialist, who recommends a lab test for him. Before making a referral and scheduling the test, though, the doctor logs in to the bcbsri.com Provider page to access the BCBSRI Participating Provider Directory, which he uses to choose and refer an in-network lab. Dan proceeds to have the test, and because the lab is in the BCBSRI network, his cost sharing for the procedure is predictable.

While these are obviously fictitious examples, unfortunately surprise/out-of-network billing is a very real scenario today. They also emphasize why it’s so important for your patients (our members) that you use in-network services, most notably labs and facilities.

Your patients rely on you to refer them for the most appropriate tests (when needed), in the most affordable setting. Network labs offer the best of all worlds for your patients and our members – including high quality, efficiency, affordability, and choice. Lab expenses may be one of the biggest contributors to healthcare consumers’ out-of-pocket costs. But by using in-network rather than out-of-network labs, you can help them save money. As you know, costs for out-of-network services can be quite significant, especially for members whose health plans don’t have out-of-network benefits. And as a BCBSRI participating provider, we’re counting on you to help protect them from the burden of non-participating lab billing.

Health plan provider networks are designed to protect patients from the high costs of surprise medical bills, with negotiated payment rates to contracted providers, facilities, and labs. Please make every effort to refer your patients to in-network labs and facilities to ensure their best possible experience and outcome.