Out-of-Network Coverage

In most cases, you must receive your care from a Blue Cross Community MMAI (Medicare-Medicaid Plan)℠ 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