Personal Choice Preferred Provider Network

Personal Choice has a selected group of physicians, hospitals and other ancillary providers to provide most of the covered medical services described in this booklet. A list of these participating providers can be found in the Personal Choice doctor and hospital directory, which will be furnished to you automatically. You may also visit IBC's web site at www.ibx.com for provider information online.

You may choose to receive medical care from any preferred provider. When you use preferred providers, the care you receive will be monitored to ensure that it is the most appropriate and cost-effective treatment required for your particular medical condition. You may receive care from any preferred provider without a referral from a primary care physician.
Utilization of preferred providers is totally voluntary on your part. However, if you use a preferred provider, you will realize the following advantages:

Preferred providers will file the claim for you.

Preferred providers will accept payment for covered services directly from Personal Choice, along with your co-payment.

You will not be billed for the balance of any covered expenses in excess of the coinsurance amounts.

Your out-of-pocket costs for covered services provided by a preferred provider will be less than your out-of-pocket costs for the same services provided by a non-preferred provider.

Personal Choice preferred providers will take care of any required pre-certification for you.

In order to encourage utilization of the Personal Choice Preferred Provider Network, there are separate benefit levels for using preferred and non-preferred providers. The benefits for using preferred providers are generally higher than those for using non-preferred providers. The benefit amounts and limits for covered services by both preferred and non-preferred providers are described in the section titled "What the Plan covers."

Preferred providers have an agreement with Independence Blue Cross to accept payment for covered services based on a pre-determined fee schedule. If you use preferred providers, the Personal Choice covered expenses will be the amount determined under the agreement between the provider and Independence Blue Cross. You will not be responsible for any charges which exceed the preferred provider's fee schedule. When you use a non-preferred provider, however, Independence Blue Cross determines the amount that Personal Choice will treat as covered expenses. Any difference between the Personal Choice covered expenses and the non-preferred provider's actual charge will be your responsibility, and the provider may bill you for this balance.