I am a SISC Blue Shield PPO plan member and will be receiving an outpatient procedure. What should be considered when selecting an outpatient facility?
- SISC Blue Shield PPO plans limit the maximum benefit amount at an in-network outpatient hospital facility for the following five procedures: arthroscopy, cataract surgery, colonoscopy, upper GI endoscopy. There is no limit for these procedures at an in-network Ambulatory Service Center (ASC).
- Contact your provider’s office and ask, “Do I need a pre-authorization?” and “Is there a cap or limit for this procedure?” “
- If you use an in-network ASC, you will only be responsible for the regular deductible and coinsurance.
- If you use an in-network outpatient hospital facility, you will be responsible for the regular deductible and coinsurance PLUS any amount by which the hospital charge exceeds the maximum benefit.
- Outpatient procedures can be safely performed at an ASC more quickly for a fraction of the cost.