What if the medical care recommended by my PCP is not available through a plan specialist or provider?
If medically necessary covered services are not available through plan physicians or providers, Health Advantage, on the request of your PCP, made within a reasonable period prior to receiving the service, may authorize covered services by a nonplan physician or provider at the allowable charge or an agreed-upon rate. Services will be covered as in-network benefits, but the member may be billed the difference between billed charges and allowable charges for services received from nonplan providers.
Related Questions
- What if the medical care recommended by a primary care physician is not available through a plan specialist or plan provider?
- What if the medical care recommended by a PCP is not available through a plan specialist or plan provider?
- What if the medical care recommended by my PCP is not available through a plan specialist or provider?
