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2025 Blue Cross and Blue Shield Service Benefit Plan - Standard and Basic Option
Section 5(b). Surgical and Anesthesia Services Provided by Physicians and Other Healthcare Professionals
Page 74

 

Benefit Description

Anesthesia (cont.)


Anesthesia services consist of administration by injection or inhalation of a drug or other anesthetic agent (including acupuncture) to obtain muscular relaxation, loss of sensation, or loss of consciousness.

Note: Anesthesia acupuncture services do not accumulate toward the member’s annual maximum.

Note: See Section 5(c) for our payment levels for anesthesia services billed by a facility.


Standard Option - You Pay
Preferred: 15% of the Plan allowance (deductible applies)

Participating: 35% of the Plan allowance (deductible applies)

Non-participating: 35% of the Plan allowance (deductible applies), plus any difference between our allowance and the billed amount

Basic Option - You Pay
Preferred: Nothing

Participating/Non-participating: You pay all charges

 

Benefit Description

Not covered:
 
  • Anesthesia related to noncovered surgeries or procedures


Standard Option - You Pay
All charges

Basic Option - You Pay
All charges

 

Go to page 73.  Go to page 75.
 

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