The term participating provider is usually used to describe providers who participate in the Medicare program. This means the provider will accept what Medicare determines for reimbursement.
♦ The opposite is non-participating provider. This provider will not accept Medicare's determination. The provider may be willing to see you but you will be charged more.
Some individual insurance plans use the term to refer to preferred providers. The term preferred provider more accurately reflects that the provider is in the plan’s network.
♦ BlueCross BlueShield has muddled this meaning some these days.
They have pharmacies that are participating pharmacies. Pharmacies that are in their network.
And then within this list of participating pharmacies are some that are referred to as preferred.
Prescriptions will be covered at all participating pharmacies but the copay will be less if the member uses the "preferred" pharmacy.
• Why you should use in-network ?
• Why you might use out-of-network ?