February > Be a Wise Healthcare Consumer

Be a Wise Healthcare Consumer

Seek Treatment from a BCBSTX Network Provider

Your UT SELECT PPO medical plan (administered by Blue Cross Blue Shield of Texas – BCBSTX) allows you the freedom of choice each time you need medical care to seek treatment from a BCBSTX network or non-network provider. There are significant out-of-pocket cost and administrative service differences between network and non-network providers.

In-network providers:

Conversely, treatment from a non-network provider will result in:

Office Visit
Aside from the basic differences listed above, you’ll pay a copay for an office visit with an in-network provider ($30 for a family care physician, $35 to see a specialist). For the same type of appointment with a non-network provider, you pay an amount to be applied toward the annual deductible rather than a certain office visit copay, and once you have met the annual deductible, additional payments will be applied to the coinsurance.

Deductible and Coinsurance
A deductible is the amount of out-of-pocket expense that must be paid for health care services by the covered individual before becoming payable by UT SELECT.  Coinsurance is a participant's share of covered services and supplies, not counting the deductible or copays. It is usually a percentage of the allowable amount.

If you seek treatment requiring the application of the deductible and coinsurance, benefits are processed as follows:



Wellness Benefits
Your UT SELECT plan will pay 100% of the cost (no copayment) for these Wellness services, if received from a participating BCBSTX in-network provider:

If the Wellness services above are received from a non-network provider, the member is responsible for the applicable deductible, coinsurance, and 100% of any charges over the allowable amount.

Additional detailed benefits information is available in the 2010 – 2011 UT SELECT Health Benefits Guide at www.utsystem.edu/benefits/pubs/medical_guide.pdf.

Using Your PayFlex Debit Card at the Dentist

Dental procedures such as teeth cleaning, sealants, fluoride treatments, X-rays, fillings, extractions, dentures and other dental ailments are all eligible expenses that can be paid for with your PayFlex Card™. However, there are a few things to remember when using your card to pay for dental expenses.

  1. Your Flexible Spending Account dollars (i.e., PayFlex Card) cannot be used to pay for cosmetic dental procedures such as dental veneers, bonding and teeth whitening.
  2. You can only swipe your card for the amount you are responsible for.
    For Example:
    • Let’s say you visit the dentist to repair a cracked composite filling.
    • You receive a bill for $300 and your dentist is estimating your out-of-pocket expense is $72.
    • In this case, since your portion is merely an estimate, you should wait to receive the Explanation
      of Benefits (EOB) from your insurance provider before using the PayFlex Card to pay for the
      filling. If insurance pays 80% of the cost, you are only responsible for paying $60.
    • To pay the $60, you may provide your dentist with the number on your PayFlex Card or you can
      pay with another form of payment and submit a claim for reimbursement.
  3. You may be required to provide an EOB to confirm that you used your PayFlex Card for an eligible
    dental expense.
    For Example:
    • Let’s say you swipe your card to pay for a dental service and the expense is approved at the point-of-sale.
    • A month later, you receive a Request for Documentation letter from PayFlex requesting
      documentation for the transaction.
    • Based on the merchant description, it is unclear what you paid for with your PayFlex Card.
      Sample: ABC Family Dentistry
      Date: 02/18/2011 Amount: $45.60 Account: (2010) Healthcare
    • In this case, an EOB or itemized statement is required to confirm the transaction was an eligible
      expense and to confirm the date of purchase or service.
    • To confirm your expense, login to www.utflex.com and upload your EOB or fax or mail your documentation and letter to PayFlex.

Please note: PayFlex is required by the IRS to ensure participants are utilizing the card for eligible
expenses. Therefore, it is important to keep all itemized statements and EOBs.