The EOB, which you receive for every claim submitted from an out-of-network provider, explains the maximum allowable fee and your financial responsibility.
You can find out the maximum allowable fee for a particular procedure prior to having a service performed. Contact your provider to request the procedure code and amount the provider will charge. Then contact our Customer Care Center at (800) 279-1301 and request information about maximum allowable fees. Within five days of your request, we will advise you whether the service is fully covered and if it is subject to any plan provisions (deductibles, co-insurance, copayments or pre-existing conditions).