When you receive care from either an in-network or non-network provider, show your medical ID card to your provider, who will submit the claim for you. Note that out-of-network benefits will apply for non-network providers.
If your claim involves an accident or injury, the PPO plan administrator needs additional information before it can process the claim, such as how and where the accident or injury occurred and whether anyone else was involved. This can affect who pays the claim. Medical providers do not include this information when they submit their claims, so the administrator will contact you to obtain it.