Seeing non-contracted providers

In an effort to manage the overall cost of healthcare, FCHP attempts to contract with as many providers as possible. However, some providers choose to remain non-contracted.

For emergency room physicians, we pay the “usual and customary” fee for their services. The usual and customary fee is based on what is usually charged for the service in the area the service was received.

Since we don’t have a contract with these providers, we can’t require that they accept the usual and customary fee as payment in full. As a result, the provider may directly bill you, the member, for the balance. If this happens, contact the providers directly to let them know that, in accordance with communication they received, your insurance company has paid the usual and customary fee.

For non-contracted ambulance, pathology and anesthesiology providers, we pay you the full amount of the bill, minus any copayment/coinsurance/deductible you may have. You then pay the provider. Note: If the person who received the service is under the age of 18, we will send this payment to the subscriber on the policy, unless there are alternate arrangements in place.

If you have any questions, please feel free to contact FCHP Customer Service at 1-800-868-5200.