When you are in need of a treatment provider, our dedicated team can help you find a recognised medical practitioner, hospital or healthcare facility within network.
Alternatively, you can view a summary of benefits providers on Facilities Finder at bupaglobal.com/en/facilities/finder.
If you have U.S. cover as part of your health plan, you have access to the broadest coverage in the U.S. via Blue Cross Blue Shield networks. To find out more please visit bupaglobalaccess.com.
Where you choose to have your treatment and services with a treatment provider in network, we will cover all eligible costs of any covered benefits, once any applicable co-insurance or deductible amount which you are responsible to pay has been deducted from the total claimed amount.
Should you choose to have covered benefits with a treatment provider who is not part of network, we will only cover costs that are Reasonable and Customary. This means that the costs charged by the treatment provider must be no more than they would normally charge, and be similar to other benefits providers providing comparable health outcomes in the same geographical region. These may be determined by our experience of usual, and most common, charges in that region.
Government or official medical bodies will sometimes publish guidelines for fees and medical practice (including established treatment plans, which outline the most appropriate course of care for a specific condition, operation or procedure). In such cases, or where published insurance industry standards exist, we may refer to these global guidelines when assessing and paying claims. Charges in excess of published guidelines or Reasonable and Customary made by an ‘out-of-network’ treatment provider will not be paid.
This means that, should you choose to receive covered benefits from an ‘out-of-network’ treatment provider:
- you will be responsible for paying any amount over and above the amount which we reasonably determine to be Reasonable and Customary – this will be payable by you directly to your chosen ‘out-of-network’ treatment provider;
- we cannot control what amount your chosen ‘out-of-network’ treatment provider will seek to charge you directly.
There may be times when it is not possible for you to be treated at a treatment provider in network, for example, if you are taken to an ‘out-of-network’ treatment provider in an emergency. If this happens, we will cover eligible costs of any covered benefits (after any applicable co-insurance or deductible has been deducted).
If you are taken to an ‘out-of-network’ treatment provider in an emergency, it is important that you, or the treatment provider, contact us within 48 hours of your admission, or as soon as reasonably possible in the circumstances. If it is the best thing for you, we may arrange for you to be moved to a treatment provider in network to continue your treatment once you are stable. Should you decline to transfer to a treatment provider in network only the Reasonable and Customary costs of any covered benefits received following the date of the transfer being offered will be paid (after any applicable co-insurance or deductible has been deducted).***
Additional rules may apply in respect of covered benefits received from an ‘out-of-network’ benefits provider in certain countries.