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Arkansas' FirstSource® PPO
A Preferred Provider Organization (PPO) is a health-care system that provides services
to members at a discount or fixed fee. As a result of the discounts agreed to by
participating (preferred) providers, charges for medical services are lower. The
lower charges save money for members, who also avoid filing claims because providers
file the claims with BlueAdvantage Administrators of Arkansas.
To receive discounts and to have claims filed by providers, members must seek treatment
from PPO-contracted physicians or facilities.
BlueAdvantage offers participation in the Arkansas' FirstSource® PPO to self-funded
employer groups. However, a group may choose to access a different network arrangement.
For information about health-care providers and hospitals who participate in the
Arkansas' FirstSource PPO® program, go to the Arkansas' FirstSource® PPO Provider Directory. You can view
the provider's hospital affiliations, board certifications and education information.
Arkansas' FirstSource® Preferred Provider Organization
Arkansas' FirstSource® PPO is a preferred provider organization offered by USAble
Corporation, a wholly owned subsidiary of Arkansas Blue Cross and Blue Shield. FirstSource
assists employers in controlling health-care costs by offering a network of doctors
and hospitals that have agreed to discount their fees. More than 4,850 health professionals
and 92 hospitals participate in the FirstSource network.
Through this statewide network of participating providers, the health plan is able
to gain access to more attractive pricing arrangements and better management of
claim costs. Adding proper utilization management to the mix, FirstSource can help
control not only the price of health-care, but also how effectively health-care
services are delivered.
Simply put, FirstSource obtains price discounts from providers and then passes them
along to employers and employees. The plan offers all the benefits of managed care
with fewer restrictions than a traditional HMO (health maintenance organization).
Patients retain their choice of health-care providers, with built-in incentives
for choosing providers within the network.
Usually, the benefit structure is similar to comprehensive major medical (CMM) plans,
featuring a calendar-year deductible, coinsurance and calendar-year coinsurance
maximum or out-of-pocket maximum. The PPO works very much like CMM in terms of benefits,
although the PPO does have some benefits that differ.
In-network PPO benefits are typically greater than out-of-network benefits because
of different coinsurance levels. This principle usually applies to copayments, deductibles
and calendar-year coinsurance maximum or out-of-pocket maximums. Lower in-network
costs steer utilization to participating providers.
Example: In-network PPO benefits may include a $100 calendar-year deductible,
$10 office-visit copayment and 90 percent benefit up to an out-of-pocket maximum
of $500. In comparison, out-of-network benefits under the plan may include a $300
calendar-year deductible, $25 office-visit copay, 70 percent benefit up to an out-of-pocket
maximum of $1,000.
The information above is an example only. The benefits designed by your employer
group are unique to your plan. Check your
Plan Benefits.
Freedom of Choice
Members may choose any health-care provider they wish from within the statewide
network and receive the benefit of the negotiated fee discounts.
Affordable Care for Employers and Employees
With FirstSource, there is no sacrifice of major medical protection. Employers also
have the flexibility to choose the deductible that best fits their group's needs.
And there are no claims to file when using a PPO doctor or hospital, which reduces
paperwork.
FirstSource offers employers a quality product at a lower cost and provides predictability
for the employer, patient and provider.
FirstSource is truly a plan with something for everyone. Employers realize cost
savings, while employees get access to the medical care they need. It's no wonder
FirstSource is the number-one PPO in Arkansas, serving more than 442,000 Arkansans.
Access Only
BlueAdvantage may not be your employer's third-party claim administrator. However,
your employer may access the Arkansas FirstSource PPO network. By payment of a monthly
fee, employers can lease access, thereby enjoying the benefit of discounted medical
services.
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