Blue Shield of California PPO

[kris1189 15]

Does anyone else have this insurance? I was told I have to paid my deductible plus copay plus 30% of the allowed amount? That's seems high to me...

[Lori Voss Green 93]

I don't have the same insurance, but I do work for and have Blue Cross Blue Shield of Illinois. If your policy has a deductible and coinsurance, then that would be correct. Whatever your deductible is would be out of pocket to you before the insurance would kick in and pay their percentage. You might want to double check and see if the provider is PPO with Blue Shield of CA. A 70/30 coinsurance sounds like it could POSSIBLY (not saying it IS) be an out of network benefit level. I would suggest double checking that.....mainly because if the provider IS out of network, anything over the allowed amount could also be your responsibility, they are not required to write that off if they are out of network.

In CA, Blue Cross and Blue Shield are separate companies, where as in the other states, Blue Cross Blue Shield is one company. So, a provider could be PPO with Blue Shield but not PPO with Blue Cross in CA, and vice versa. So, I would be sure the person and facility you are going through are PPO/In Network with the insurance you have specifically. Again, the reason being you get a higher benefit level (the coinsurance part), the deductible is almost always lower in network, and most importantly, the PPO provider is contracted to write off what is over the allowed amount while an out of network provider is not and can bill anything over that allowed amount to you.