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Network:
A group of health care providers under contract with Blue Cross and Blue Shield of
Georgia within a specific geographic area.
Non-Participating Provider:
A non-participating provider is a physician, hospital or other medical provider that
has not entered into an agreement with BCBSGa to provide health care services to
members.
Out-of-Pocket:
Those medical expenses which an insured is required to pay because they are not
covered under the group contract.
Open Enrollment:
A period when eligible persons can enroll in a health benefits plan.
Outpatient:
A patient who visits a clinic or hospital to receive medical diagnosis or treatment, but
does not occupy a hospital bed for a specified minimum stay.
Participating Provider:
A participating provider is a physician, hospital or other medical provider that has
entered into an agreement with BCBSGa or Blue Cross and Blue Shield Healthcare Plan
of Georgia to provide health care services to members.
Physician’s Current Procedural Terminology (CPT):
A list of medical services and procedures performed by physicians and other
providers. Each service and/or procedure is identified by its own unique 5-digit code.
CPT has become the health care industry’s standard for reporting physician
procedures and services, thereby providing an effective method of nationwide
communication.
Point-of-Service:
A managed care product that offers the advantages of an HMO with the flexibility of a
traditional health insurance plan. Members decide where to receive care when they
need itat the point-of-service.