Out-of-Network Coverage

In most cases, you must receive your care from a Blue Cross Community MMAI 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. Examples 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

For more information contact Member Services or read the Member Handbook External link to a PDF displaying the Member Handbook.

 

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