Out-of-Network Benefits

To receive the highest level of coverage, you should obtain your health care services and supplies from covered providers who participate in the Harvard University Group Health Plan provider network. For some health care services, you may need a referral from your primary care physician or approval from your health plan in order to receive coverage.

HMO Members

To receive coverage, HMO members must obtain all of your health care services and supplies, except emergency and approved urgent care, from covered providers who participate in the HMO Blue network.

POS and POS Plus Members

POS and POS Plus members have the option of managing their own health care and receiving health care and services from providers who are not in the Harvard University Group Health Plan network. If you decide to use your out-of-network benefits your out-of-pocket costs will be higher, and you may also be balance billed for the difference between the actual charges and the Blue Cross Blue Shield of Massachusetts allowed amount for covered services.

HDHP Members

When you see in-network providers your cost share will be calculated based on the allowed charge, or the provider’s actual charge if it is less than the allowed charge. You will not have to pay charges that are more than the allowed charge for covered services. When you see an out-of-network provider, your out-of-pocket costs will be higher, and you may also be balance billed for the difference between the actual charges and the Blue Cross Blue Shield of Massachusetts allowed amount.

Claims Process

If you elect to use your out-of-network benefits, you may have to pay for covered services rendered and file for reimbursement using this Blue Cross Blue Shield of Massachusetts claim form. Once you have met your deductible, you will be reimbursed for covered services minus your applicable coinsurance. You can view the status of your claim at Blue Cross Blue Shield MyBlue—it can take up to 60 days to process a claim. You will need to create a secured login to view your claims status. Learn more