Frequently Asked Questions

 
Frequently Asked Questions

What is a PPO?
PPO stands for Preferred Provider Option, which is a network of contracting providers. The PPO plan gives you freedom of choice, flexibility, and a broad range of benefits. There is no need to select a primary care physician because you can choose a doctor whenever you need care. Also, you do not need a referral to see a specialist or to get another opinion. When you receive care from a contracting PPO provider, you will receive a higher level of benefit than if you use a provider outside of the PPO network.

How can I find a PPO doctor in my area?
There are several ways to find a contracting PPO doctor or hospital.

  • Look up PPO doctors and hospitals in the Provider Finder(R)
  • Call Blue Cross and Blue Shield Customer Service at 800-55-SYSCO (800-557-9726), select option 1 (medical).
  • Call Blue Card Access at 800-810-BLUE (800-810-2583).

Do I need to choose a PPO doctor and hospital when I enroll?
No, you can select a PPO provider each time you need care.

Where should my provider file my claim?
Most providers are familiar with the PPO/BlueCard® program and know how to file their PPO patient's claims. Providers can refer to the back of ID card for instructions on how to file your claim with your local Blue Cross and Blue Shield plan.

Providers negotiate discounts with their local Blue Cross plans. In order for you, the member, to benefit from those discounts, the providers must file the claim with their local plan. The local plan then exchanges information with Blue Cross and Blue Shield of Illinois to insure that the benefits are paid appropriately.

What is the Medical Services Advisory (MSA) and what do I have to precertify?
The Medical Services Advisory is a unit of health care professionals who help you understand your health care benefits when your doctor recommends inpatient hospital treatment, you are admitted to the hospital in an emergency, or are expecting a baby. The Blue Cross and Blue Shield MSA staff includes registered nurses and licensed physicians.

You, a family member or friend must call the MSA two business days prior to any elective hospitalization and within two business days after an emergency or maternity admission. The MSA is available 7:00 a.m. to 7:00 p.m., Central time, Monday - Friday. You may also leave a message after hours and on weekends and the MSA will call you back the next business day.

If the Sysco plan is administered by Blue Cross and Blue Shield of Illinois, why does my provider file my claims with the local Blue Cross and Blue Shield?
Most providers are familiar with the PPO/BlueCard® program and know how to file their PPO patient's claims. Providers can refer to the back of ID card for instructions on how to file your claim with your local Blue Cross and Blue Shield plan.

Providers negotiate discounts with their local Blue Cross plans. In order for you, the member, to benefit from those discounts, the providers must file the claim with their local plan. The local plan then exchanges information with Blue Cross and Blue Shield of Illinois to insure that the benefits are paid appropriately.

How will I know that my claim has been paid?
You will receive an Explanation of Benefits (EOB) from Blue Cross and Blue Shield of Illinois once your claim has been processed. The EOB will provide details of what was covered, the level of coverage, and any amount you may owe.

You can also log onto Blue Access for Members, Blue Cross and Blue Shield of Illinois’ online self-service tool. After you obtain a password, you can check the status of a claim, request duplicate EOBs, verify your eligibility status, or request that you be notified by e-mail when one of your claims has been processed.

Can I pay up front at the time of service and submit the claim myself?
When you receive care from a contracting PPO provider there are no claim forms to complete, no up front payments for medical services (with the exception of copayments and charges for non-covered services if applicable) and no “balance billing,” because PPO providers have agreed to accept Blue Cross and Blue Shield negotiated rates as payment in full. Also, there are significant group savings when you use a network PPO provider. If you pay the full cost of the claim at the time of service, there is a strong possibility you will over-pay your provider and the provider will be responsible for reimbursing you for payments made in excess of the PPO allowance.

Can I contact my local Blue Cross and Blue Shield office to check the status of my claim or to question benefits?
Your local Blue Cross and Blue Shield plan will not be able to assist you. The Blue Cross and Blue Shield Customer Service Center representative is thoroughly trained on Sysco plan benefits and will be able to assist you with questions. Call 800-55-SYSCO (800-557-9726), select option 1 (medical).

What if I do not use a doctor in the PPO network?
If you receive services from a non-contracting PPO provider, your benefits are covered at a lower level. You may also be responsible for paying any difference between the non-contracting PPO physician's charges and the Blue Cross and Blue Shield allowance.

The PPO network includes nearly half a million contracting physicians and specialists and more than 5,000 contracting hospitals across the country. If you use the PPO network, you will receive a higher level of coverage.

If my PPO doctor has suggested a specific treatment will it be covered?
Benefits are determined per the guidelines of your plan. If you have questions regarding the availability of benefits for a specific service, please call 800-55-SYSCO (800-557-9726), select option 1 (medical).

If my PPO provider refers me to a non-PPO provider, what level of reimbursement will I receive for the non-PPO provider's services?
You will receive the lower level of benefit. Ask your provider to help you find a contracting specialist. Remember, you do not need a referral from your primary care doctor; you may see any specialist at any time, and if you use a PPO contracting specialist your benefits will be paid at a higher level.

If I receive services from a non-PPO provider, do the charges over the PPO allowance apply to my yearly deductible or out-of-pocket?
Ineligible expenses and charges over the PPO allowance do not apply to your yearly deductible or out-of-pocket maximum.

How can I check the status of my claims?
Call Blue Cross and Blue Shield Customer Service at 800-55-SYSCO (800-557-9726), select option 1 (medical). Customer service representatives can advise you on the status of any processed claim, as well as those that are still being reviewed or processed.

You can also log on to Blue Access® for Members to check the status of your claims online as well as request duplicate EOBs, verify your eligibility, and request to be notified by e-mail after one of your claims has been finalized. If you haven’t already done so, be sure to register today!

Who do I contact to make an address change or to report a family status change?
Please contact your local Sysco Benefits Representative to make any address or family status change.

If I receive emergency care at a non-PPO hospital, what level of reimbursement will I receive?
All emergency care is paid at the higher, in-network level, after a $100 copay regardless of whether you receive care in a contracting PPO facility or a non-contracting facility.

How many cards will I receive and will my family members receive their own identification cards?
PPO participants with single coverage will receive one ID card. Participants with family coverage will receive two cards. Beginning January 1, 2004, if you want additional cards, call Blue Cross and Blue Shield at (800) 55-SYSCO/ (800) 557-9726 (Select Option 1, Medical), or request an additional card on this Web site.

What do I do if I lose my ID card?
You can print a temporary card and request new cards can be ordered through your secure Blue Access® for Members account. You can also order a new card by calling 800-55-SYSCO (800-557-9726), select option 1 (medical).

How do I obtain a Blue Cross and Blue Shield of Illinois claim form and where do I mail it?
You can download the claim form. The address on where to mail the claim is on the form.

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