![]() ![]() (See your Evidence of Coverage for information about what to do if you receive a bill or if you need to ask for reimbursement.) Or, if an out-of-network provider sends you a bill that you think we should pay, you can submit it to us for processing and determination of your liability, if any. But, if you have already paid for the covered services, we will reimburse you for our share of the cost for covered services. It is best to ask an out-of-network provider to bill the plan first.(See your Evidence of Coverage for information on your appeal rights.) ![]() If we say we will not cover your services, you have the right to appeal our decision not to cover your care. Without a pre-visit coverage decision, if we later determine that the services are not covered or were not medically necessary, we may deny coverage and you will be responsible for the entire cost.(See your Evidence of Coverage for information about asking for coverage decisions.) This is important because: However, before getting services from out-of-network providers you may want to ask for a pre-visit coverage decision to confirm that the services you are getting are covered and are medically necessary. You don’t need to get a referral or prior authorization when you get care from out-ofnetwork providers.Check with your provider before receiving services to confirm that they are eligible to participate in Medicare. If you receive care from a provider who is not eligible to participate in Medicare, you will be responsible for the full cost of the services you receive. ![]() We cannot pay a provider who is not eligible to participate in Medicare. You can get your care from an out-of-network provider however, that provider must be eligible to participate in Medicare.Here are other important things to know about using out-of-network providers: However, if you use an out-of-network provider, your share of the costs for your covered services may be higher. Our plan will cover services from either in-network or out-of-network providers, as long as the services are covered benefits and are medically necessary. How to get care from out-of-network providersĪs a member of our plan, you can choose to receive care from out-of-network providers. You may also refer to your Evidence of Coverage (EOC) for more information, including the cost-sharing that applies to out-of-network services. Calls will be returned the next business day, or visit. From April 1 to September 30, on weekends and holidays you may be required to leave a message. Please call our Member Service Department at 1-88, 8 a.m. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Out-of-network providers are under no obligation to treat Blue Advantage's enrollees, except in emergencies. Please visit Doctor locator to find an in-network dentist. ![]() For allowable preventative and comprehensive dental services, a member's cost may be less if services are received from a dentist within network. Please call 1-84 to locate a TruHearing provider and to schedule an appointment. If you request it, your request for hard copies of the provider directory remains until you leave Blue Advantage or request that hard copies be discontinued.įor Routine Hearing Exams and Hearing Aids services, you must use a TruHearing provider. Blue Advantage may ask whether your request for a hard copy is a one-time request or if you are requesting to receive the provider directory in hard copy permanently. Blue Advantage will mail a hard copy of the provider directory to you within three (3) business days of your request. Calls will be returned the next business day. To request a hard copy of Blue Advantage’s provider directory, please call our Member Service Department at 1-88, 8 a.m. Other providers are available in our network. You may go to any of our network providers listed in this directory. The network providers listed in this directory have agreed to provide you with your health care, vision and dental services. To get detailed information about your health care coverage, please see your Evidence of Coverage (EOC). This directory provides a list of Blue Advantage’s network providers. Provider Directory Information Blue Advantage (PPO) Complete and Premier ![]()
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