35 Preferred Provider Organization The Plan contracts with CareFirst Administrators or access to a nationwide preferred provider network (PPO). If you utilize services provided by physicians, other health care professionals, hospitals, or other health care facilities in the CareFirst Administrators network this will result in less cost to you and the Plan. When you select a CareFirst Administrators participating provider for your medical services, you will have, in general, a higher percentage benefit payment and a lower out-of-pocket cost than if you select to receive those services from a non-participating provider. CareFirst Administrators participating providers have agreed, by contract, to accept payments from the Plan for services and benefits at discounted levels negotiated by CareFirst Administrators. When you are seeking services from a provider, please present your medical ID card at each visit. The card identifies you as a CareFirst Administrators network participant and gives the participating provider necessary billing information for purposes of submitting your claims. Note: you are not required to use a CareFirst Administrators provider. It is your choice. However, both you and the Plan will experience savings if you choose to utilize an in-network provider for your medical needs. Participating providers in the CareFirst Administrators network include physicians, hospitals, other health care professionals, and other health care facilities. To find participating providers in the CareFirst Administrators network, please access the Plan’s website at www.iambtf.org or the www.cfablue.com member portal. You also may get CareFirst Administrators network provider information by calling Quantum Health at the toll-free number shown on the back of your identification card, 866-871-0839. We recommend that you confirm a provider’s current participation in the CareFirst Administrators network by calling CareFirst Administrators directly before treatment. If you would like a paper directory of providers, please contact CareFirst Administrators at the number on your medical identification card to request a copy for your zip code area. If you need assistance, please contact Quantum Health at 866-871-0839. Applicability of In-Network Benefits You must utilize a CareFirst Administrators network provider to obtain in-network benefits with the accompanying financial advantages. The following are exceptions to this rule: Emergency Medical Care Whenever possible, you should request treatment from CareFirst Administrators providers. However, benefits will be provided at the in-network level for all Medically Necessary Emergency Services associated with true medical Emergencies that are received in the Emergency Room of both in-network and out-of-network hospitals. If You’re Not Able to Access an In-Network Provider Except where benefits are specifically limited to in-network providers, if there are no CareFirst Administrators providers within a 25-mile radius of your home, benefits will be provided at the in-network level for any covered provider that is located in the 25-mile radius, regardless of network participation
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