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  5. 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?

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.