Dear Health Care Provider:

This manual is dedicated to keeping you and your staff informed regarding our operational policies and procedures at Blue Cross and Blue Shield of Nebraska (BCBSNE).

The contents of this manual are contractually binding for compliance, based on your provider agreement with BCBSNE. Providers will follow all applicable BCBSNE Policies and Procedures and those applicable to the Covered Person, and Provider agrees to provide appropriate information to Provider employees, agents and representatives consistent with this commitment.

It is important to familiarize yourself with the information provided within this manual, and have it readily available as a reference. For your convenience, the manual is available for access online at www.nebraskablue.com by clicking on “Providers and then on “Policies and Procedures” in the left column. The online version of the manual contains the most current and updated information.

If you have any suggestions as to how we can improve this manual as a comprehensive resource for you, please let us know.


Jeni Alm, Vice President

Health Network Services



The percentage of the bill you pay after your deductible has been met.


A fixed amount you pay when you get a covered health service.

Tiered benefit plan

A health care plan featuring multiple levels of benefits based on the network status of a particular provider. 


The annual amount you pay for covered health services before your insurance begins to pay.

emergency care services

Any covered services received in a hospital emergency room setting.


Includes behavioral health treatment, counseling, and psychotherapy

in-network provider

A provider contracted by your insurance company to accept an agreed upon payment for covered services. 

OUT-OF-network provider

A term for providers that aren’t contracting with your insurance company. (Your out-of-pocket costs will tend to be more expensive if you go to an out-of-network provider.)


Your expenses for medical care that aren’t reimbursed by insurance, including deductibles, coinsurance and co-payments.


If you can afford health insurance, but choose not to buy it, you must have a health coverage exemption or pay a tax penalty on your federal income tax return.


The amount you pay to your health insurance company each month. 

Preventive services

Health care services that focus on the prevention of disease and health maintenance.


Services and devices to help you recover if you are injured or have surgery. This includes physical, occupational and speech therapy.

special enrollment period

The time after the Open Enrollment Period when you can still purchase health insurance only if you have a qualifying life event (losing other health coverage, having a baby, getting married, moving).


A physician who has a majority of his or her practice in fields other than internal or general medicine, obstetrics/gynecology, pediatrics or family practice.