In most cases, care you receive from an out-of-network provider (a provider who is not part of our plan’s network) will not be covered. Here are three exceptions:
- The plan covers emergency care or urgently needed care that you get from an out-of-network provider.
- The plan covers dialysis services for ESRD enrollees who traveled outside the plan’s service area and are not able to access contracted ESRD providers.
- If you need medical care that Medicare requires our plan to cover and we do not have providers available in our network to provide the service, you can get this care from an out-of-network provider. You will need to obtain authorization from the plan prior to seeking care. In this situation, you will pay the same as you would pay if you got the care from a network provider.
For detailed information refer to your plan’s Evidence of Coverage or contact Member Services.