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Bowdoin College PPO Health Plan Preferred In-Network Providers

Why does the College offer a “Preferred In-Network” benefit for the Bowdoin College PPO Health Plan?

The Preferred In-Network benefit helps both you and the College get the best value out of the money spent on health care.  Rising healthcare costs are a challenge for everyone, and this is one way to receive high quality care at a lower cost. 

What does it mean to use a “Preferred In-Network” provider? 

If you choose to receive covered services from a Preferred In-Network provider, you will have: 

  • Lower deductible
  • Lower out-of-pocket costs

 Who are the Preferred In-Network providers? 

  • Mid Coast Hospital (Brunswick)
  • Maine Medical Center (Portland)
  • Maine Heart Center (Portland)
  • OA Centers for Orthopaedics (all locations including Brunswick) 

What are the savings and how are the savings applied to the plan? 

For services billed directly by Mid Coast Hospital, Maine Medical Center and the Maine Heart Center that are normally subject to the deductible and the coinsurance, the deductible is reduced to $100 per individual/$200 per family (regular in-network deductible is $500/$1,000) and the out-of-pocket calendar year maximum is reduced to $1,500 per individual/$3,000 per family (regular in-network $2,500/$5,000).  For OA Centers for Orthopaedics the savings is in connection with the copayment for office visits and physical therapy visits which is reduced to $20 versus the regular in-network copayment of $40 per visit for a specialist office visit.  The negotiated savings to the plan by using one of these providers is applied to lower your deductible and reduce your out-of pocket maximum that would otherwise be charged for services at these providers. 

What happens if I go to a provider that is not on the Preferred In-Network provider list? 

You can use any Anthem in-network provider in Maine and across the United States.   If you wish to go to a provider who is not a Preferred In-Network provider, you may do so and the regular deductible ($500 per individual/$1,000 per family) and the regular out-of-pocket maximum ($2,500 per individual/$5,000 per family) apply.  The plan also provides out-of-network benefits, but it is important to remember that the reimbursement for out-of-network benefits is significantly lower.  Out-of-network benefits are subject to the deductible and then covered at 60% of the maximum allowance. 

How did the College choose these providers and why isn’t my hospital on the list? 

Bowdoin College is concerned about employees’ health and well-being.  The College also wants to make sure we get the best value for the money that you and the College spend on healthcare.  It is also important to find providers in our community that provide quality care at a reasonable price.  When you choose a doctor or hospital, the price is important, but the quality of care and the outcome is even more important.  Mid Coast Hospital, Maine Medical Center, the Maine Heart Center and OA Centers for Orthopaedics entered into discussions with the College and agreed to partner with us to implement strategies to maintain and/or improve high quality efficient care.  If your hospital is not on the list, it does not mean that your hospital or provider does not provide quality care.