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 provider
• 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