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PROVIDERS No. As a MACo Health Care Trust participant, you are never required to see providers who are members of Preferred Provider Organizations or networks. Some PPO network logos are displayed on the back of your MACoHCT card, but you can see any licensed provider you choose, even if they are not members of those networks. Why should I care about preferred provider networks? Although you are not required to see in-network providers, there are distinct advantages to doing so. For one thing, you know you are getting the best deal possible, thanks to agreements in place with the networks. Also, in-network providers will not bill you for any amount that exceeds the MACoHCT allowable fee, even if they normally would charge more for the service you received. The allowable fee is based on the 90th percentile of "usual, customary and reasonable" (UCR) charges for each service. (Keep in mind that you are always responsible for meeting your plan’s deductible and for paying any required co-payment amount.) If you see out-of-network providers, those providers may bill you for any amounts that exceed the MACoHCT allowable fees. This is called “balance billing,” and you can avoid it by visiting in-network providers. Is my doctor a member of any preferred provider networks? Use this link to see which preferred provider networks are applicable for your plan: https://www.abpmtpa.com/pposelector/pposelector.aspx . From there, you can access each network’s website to search for a specific provider. Most providers in Montana belong to at least one of the networks. Tips for using this link:
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