74 Provider Network Status The Maximum Allowed Amount may vary depending upon whether the Provider is an In - Network Provider or an Out - of - Network Provider. An In - Network Provider is a Provider who is in the managed network for this specific product or in a special Center of Medical Excellence /or other closely managed specialty network, or who has a participation contract with us. For Covered Services performed by an In - Network Provider, the Maximum Allowed Amount for this Booklet is the rate the Provider has agreed with us to accept as reimbursement for the Covered Services. Because In - Network Providers have agreed to accept the Maximum Allowed Amount as pa yment in full for those Covered Services, they should not send you a bill or collect for amounts above the Maximum Allowed Amount. However, you may receive a bill or be asked to pay all or a portion of the Maximum Allowed Amount to the extent you have not met your Deductible or have a Copayment or Coinsurance. Please call Member Services for help in finding an In - Network Provider or visit www.anthem.com . Providers who have not signed any contract with us and are not in any of our networks are Out - of - Network Providers, subject to Blue Cross Blue Shield Association rules governing claims filed by certain ancillary providers. For Covered Services you receive from an Out - of - Network Provider, the Maximum Allowed Amount for this Plan will be one of the following as determined by us: 1. An amount based on our Out - of - Network Provider fee schedule/rate, which we have established in our discretion, and which we reserve the right to modify from time to time, after considering one or more of the following: reimbursement amounts accepted by li ke/similar providers contracted with us, reimbursement amounts paid by the Centers for Medicare and Medicaid Services for the same services or supplies, and other industry cost, reimbursement and utilization data; or 2. An amount based on reimbursement or cost information from the Centers for Medicare and Medicaid Services (“CMS”). When basing the Maximum Allowed amount upon the level or method of reimbursement used by CMS, Anthem will update such information, which is adjusted or unadjusted for geographic locality, no less than annually; or 3. An amount based on information provided by a third - party vendor, which may reflect one or more of the following factors : (1) the complexity or severity of treatment; (2) level of skill and experience required for the treatment; or (3) comparable Providers’ fees and costs to deliver care, or 4. An amount negotiated by us or a third - party vendor, which has been agreed to by the Provider. This may include rates for services coordinated through case management, or 5. An amount based on or derived from the total charges billed by the Out - of - Network Provider . Providers who are not contracted for this product but are contracted for other products with the Plan are also considered Out - of - Network. For this Plan , the Maximum Allowed Amount for services from these Providers will be one of the five methods shown above unless the contract between us and that Provider specifies a different amount. For Covered Services rendered outside our Service Area by Out - of - Network Providers, claims may be priced using the local Blue Cross Blue Shield plan’s non - participating provider fee schedule / rate or the pricing arrangements required by applicable state or federal law. In certain situations, the Maximum Allowed Amount for out of area claims may be based on billed charges, t he pricing w e w o u l d use i f t h e h e al t h c are s e r v ic es h a d b e en o b t a i n e d w i th i n the our S er v i c e A r e a, or a s p e c i al n e g o t i at e d price.