Out-of-Network Coverage

In most cases, you must receive your care from a Blue Cross Community MMAI (Medicare-Medicaid Plan)SM in-network plan provider. There are some exceptions when care you receive from an out-of-network provider will be covered. Those exceptions are:

  • Emergency care or urgently needed care
  • Out of area dialysis services
  • Continuity of care or if you need care that cannot be adequately provided by a network
  • Unusual circumstances that may require prior authorization. 

Some examples of situations that may require prior authorization are:

  • You have a unique medical condition and the services are not available from in-network providers
  • Services are available in-network but are not available as soon as you need them
  • Your PCP determines that a non-network provider can best provide the service