Testing the abilities - Regence BlueShield

Referral to an Out-of-Network Provider
There will be occasions when a RealValue member will require treatment for a
covered service, from specialty provider or facility not included in the
RealValue provider network.
Example
• A RealValue pediatric member requires surgery (for a covered service) at Seattle
Children’s or Mary Bridge Children’s: The RealValue network has in-network
pediatricians, but no pediatric hospitals, the pediatrician will need to refer the patient for
medically necessary surgery to an out-of-network facility
• Single case agreement is negotiated with the non-contracted
provider/facility- Services covered @ contracted rates; member subject to
applicable copay, deductible and coinsurance.
• Negotiated single case agreement is not reached- Member subject to
applicable copay, deductible and coinsurance. Regence will pay billed charges
to ensure the member is not balanced billed. (OIC requirement)
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