Claims for services from out-of-network providers
Other than for emergency and urgent care, you need pre-approval on any care you receive from out-of-network providers before we'll pay for their claims. Learn more about pre-approval for care.
If you get pre-approval, we'll process the claim as if it were from an in-network provider and you can track claim status in your member account.
If you didn't get our approval before you received health care from an out-of-network provider, you will be responsible for 100% of the payment for that care. You can't submit the claim to us for payment. The amount you pay will not apply to your deductible, coinsurance or out-of-pocket limit.