In-network vs. Out-of-Network & Travel Issues

What coinsurance will I pay if I use an out-of-network provider?

  • UnitedHealthcare plans: You'll pay 50% coinsurance after you meet the deductible. You may also be required to pay the difference between the provider's charge and the Usual, Reasonable and Customary charge.
  • Blue Cross Blue Shield plan: You'll pay 100% of the bill since the plan does not include benefits for out-of-network providers and services. The only exception is for life-threatening emergencies.

For the Caterpillar NetWork, if an in-network provider refers me to an out-of-network specialist, how will my claim be paid?
To receive the highest benefit level, you should always attempt to seek services from a network provider. You have access to a program through UnitedHealthcare called National Reciprocity, and that program gives Caterpillar NetWork members access to most of UnitedHealthcare's network providers across the country (hospitals, facilities, physicians and other healthcare providers) at their network-contracted rates.

Access to National Reciprocity in the State of Illinois has been limited, but is available in all other states. You may also contact a UnitedHealthcare customer care professional at 1-866-228-4215, Monday-Friday, 7 a.m.-5 p.m. (Central time).

If you travel to a different location for a few months, how do you avoid out-of-network charges?
If you are traveling for part of the year, you may want to contact the Caterpillar Health Enrollment Center for a temporary address change to receive mail at this address. This temporary address change will not impact your network requirements or place you in a different network plan. If you are in a network plan, contact your plan administrator (UHC or BCBS) or visit their websites/use their mobile apps to find network providers in that area to receive the highest benefit level. 

How is Out-of-Network handled when someone is traveling or on vacation?
If you are in the PPO or CDHP:
When traveling for the company or on vacation and medical care is needed, office-based services for a non-emergency situation are payable at the In-Network level. Hospital services for non-emergency situations are subject to Plan guidelines and payable at the Out-of-Network level unless a network hospital is used. Contact UHC if you feel you claim was not properly considered as outlined above.

UHC network participants are required to use a network physician to receive the highest benefit level. Use of a non-network hospital for non-emergency care will be processed at the Out-of Network level.

Participants in Out-of Area plans or Indemnity plans are not subject to network rules.

If you're in the BCBS National plan option:
Blue Cross Blue Shield is a national preferred provider network. To locate a network provider, contact BCBS at the phone number on the back of your ID card. As a reminder, there is no coverage for out-of-network services except in the case of a true emergency.

If someone is injured while out-of-network, will the emergency benefit still cover at in-network amounts?

Yes. The in-network co-insurance levels still apply when an emergency situation happens out-of-network. We follow the same definition of “emergency” as defined by UHC and BCBS. Definition of true emergency: Sickness or injury that could be life-threatening or cause serious harm to the patient's bodily functions such as apparent heart attacks, severe bleeding, loss of consciousness, convulsions, fractures, severe or multiple injuries.