Out of Network Care

Many doctors and hospitals participate with us.  They are called the “network.”  There may be a time when you need to use a doctor or hospital that is not a part of our network.  If this happens, your PCP can call us to make this request.  We will check to see if there is a doctor or hospital within our network that can give you the same care.  If there is a doctor or hospital within the network, we will let your doctor know.

New members have the right to keep seeing an out of network doctor to finish a course of treatment.  The doctor must agree to our guidelines.  If you have been getting ongoing care from a doctor that is not a network doctor, and you need to stay with this same doctor to finish a course of treatment, please call Member Services at 855-412-8001; the TTY number is 711 or 1-800-982-8771 for help. 

Please keep in mind that any services received from providers not in our network must be approved by us; otherwise you may have to pay for them.

If a request to use a doctor or hospital outside of our network is denied, you can file a complaint with us by calling Member Services at 855-412-8001; the TTY number is 711 or 1-800-982-8771.  If you receive services from a provider that is not in our network without approval, that provider may be allowed to bill you.