Newsletters
Understanding Provider Networks
First Choice Provider Network
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The First Choice Provider Network is a group of health care professionals who have agreed to give quality care at a reduced price, translating to reduced costs and increased benefits for all members. First Choice provider claims are paid with Health Reimbursement Account (HRA) dollars. After your HRA dollars are exhausted, LSU First will pay claims at 100 percent. If you see a First Choice provider, you will always pay $0 out-of-pocket.
We are continuously trying to recruit providers for the First Choice network to meet all members’ needs.
Please click here to search for First Choice providers.
In-Network Providers:
CIGNA Open Access Plus Network and Verity Health Network
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CIGNA Open Access Plus Network offers wide-ranging access to national and local providers. Verity Health Network offers members robust local-only provider coverage. When you seek care from in-network providers, your claims are paid at a negotiated, discounted rate. Claims are paid using your HRA dollars until they are exhausted. Afterwards, you will be responsible for paying all claims until you meet your remaining deductible. Once your deductible is met, you will be responsible for 10 percent of the negotiated bill up to the in-network, out-of-pocket maximum. Once met, LSU First would pay 100 percent of in-network claims for the rest of the plan year.
Please keep in mind that your deductible and plan maximums will be reset every July 1st.
Out-of-Network Providers
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If a provider does not participate in the First Choice, CIGNA Open Access Plus, or Verity provider networks, then any services that are provided will be paid at the out-of-network level.
We want you to feel comfortable using any provider you wish, but also realize your out-of-pocket costs will be much higher when going to an out-of-network provider. First Choice and in-network providers agree to reduced pricing from their billed charges and also agree not to bill you the difference between the reduced pricing and their total billed charges. When you use an out-of-network provider, LSU First will calculate out-of-network benefits based on a Maximum Reimbursable Charge (MRC) --this is often referred to as the Usual and Customary (U&C) or Reasonable and Customary. Because there is no contract in place to protect you, the provider has the right to bill you any difference between this MRC and their billed charges. This difference is not a covered expense and is neither eligible to be paid with your HRA dollars nor counted toward satisfying your deductible or your out-of-pocket maximum.
An out-of-network claim will be paid using HRA dollars up to the MRC. You will be responsible for paying any amount over the MRC even if you have HRA dollars available. Once your HRA is exhausted, you will be responsible for the entire bill until your deductible is satisfied. Once your deductible has been met, you will be responsible for 30 percent of the MRC plus any additional charges. Only 30 percent of the MRC will accumulate towards your out-of-network, out-of-pocket maximum.
While the plan has no contract in place to reduce billed charges for an out-of-network provider, we strongly urge you to contact the provider directly and request an additional discount. LSU First has no way to require an out-of-network provider to contract with the plan.
IMPORTANT NOTICE
When you go to a hospital, there are services that may be outsourced to out-of-network providers also known as “hospital-based physicians.” These services can include Anesthesia, Radiology, Pathology, Emergency Care, or Neonatology. We strive to contract with hospital-based physicians at our First Choice and In-network hospitals, but be aware neither LSU First nor the hospital can require that they contract with LSU First and out-of-network costs may apply.