Frequently Asked Questions

Frequently Asked Questions Regarding Insurance Coverage with Blue Cross Blue Shield

What if I'm in the middle of a treatment plan with my provider on April 30, 2023?  Will I still be able to receive care?

As a Blue Cross Blue Shield insurance member, you will need to contact BCBS at 1-855-462-1784 to request a “continuity of care.” This is a standard procedure for situations which could include, but not limited to, OB patients, cancer treatment, and rehabilitation. We recommend that you also request confirmation of approval from BCBS in writing for your records and share a copy with our business office.

What if I have a medical emergency and need to go to the ER?

Emergencies are covered regardless of network status.  We highly recommend you always go to the nearest ER or call 911 if you are having a medical emergency.

Why are SMC and BCBSOK currently not able to come to terms on a new contract? 

Hospitals across the industry, including SMC, have seen historic cost increases because of the pandemic. BCBSOK, to date, has not acknowledged these cost increases. SMC does not want to eliminate services that we believe are vital to this community and so we cannot accept the reimbursement BCBSOK has offered to SMC. 

Does this only affect BCBS Oklahoma Plans?

All Blue Cross Blue Shield commercial and federal products will be out of network. However, this does not include the majority of Medicare supplements.

Will this happen with other health insurance providers? 

At this time, all commercial health insurance providers with which Stillwater has an ongoing contractual relationship are meeting our reimbursement needs to align with inflation and increased costs. 

Aren’t you renovating? How is all the construction going on? 

Construction and improvements you see today are the result of planning that began several years ago, prior to the pandemic, using funds specifically designated for that purpose. The planning for many future projects has since come to a halt as a result of increased costs and insufficient reimbursements.  

Well-appointed facilities and equipment with enough room to serve patients is key to high-quality care. 

What should I do if I am currently with BCBSOK?

1. Educate yourself on what your in-network and out-of-network differences are.

2. Connect with your employer to learn what other options you may have.

3. Contact BCBSOK directly at the Customer Service number listed on your insurance card.

I don't really know what to do. My employer only offers BCBS, what are my options?

1. SMC contracts with many payers. See our list of insurance plans and networks to consider. 

2. Self-funded employers may want to meet with SMC to explore options for direct access to specific services that lessen the need to find other providers or search for in-network solutions out of town.  

3. If you purchase your insurance through the Market Place, you can change insurance plans during the next open enrollment period, beginning November 1, or contact Healthcare.gov to see if your situation qualifies for a special enrollment change. 

4. Open enrollment periods generally occur in the last quarter of the year. Discuss options with your employer.  If you purchase your insurance through the Market Place, you can directly review other options during the next open enrollment period or inquire at healthcare.gov. There are also special enrollment periods for qualifying circumstances. 

When my Stillwater doctor becomes out-of-network with BCBS, how much will my cost increase?  

1. Individuals can identify their most common health care needs and check their policy for out-of-network coverage. Depending on your specific policy, it is common for your office visit to be covered and you will now owe a percentage of the office visit amount set by BCBS.  30% - 50% are common patient responsibility amounts. Annual deductibles will not typically apply to doctor office visits.   

2. An important item to note: BCBS pays the patient directly when they go to out-of-network providers and makes the subscriber responsible for resolving all balances with the care provider. Make a proactive plan to pay at the time of service and receive reimbursement from BCBS for the insurance plan’s portion of the cost.   

3. Consider asking your employer, or for self-funded plans ask your insurance plan, to consider Single Case Agreement for surgical or continuing care needs (such as cancer treatment). 

I have Medicare primary and BCBS as a secondary from my pre-retirement employer. Do I need to worry about being out of network? 

1. Many employer-sponsored Medicare Secondaries act as a Medicare supplement when you receive care from any Medicare participating provider. We have confirmed that the OSU and other local employer-sponsored Medicare secondaries do not require a network affiliation.  

2. Individuals are encouraged to contact your secondary plan to confirm you are covered at any Medicare participating provider regardless of BC network status.