If you’re enrolled in an Innovation Health Medicare Plan (HMO)
If you get coverage from an out‐of‐network provider, your plan won’t cover their charges. Medicare and Innovation Health Medicare won’t be responsible either.
Generally, you must get your health care coverage from your primary care physician (PCP). Your PCP can issue referrals to participating specialists and facilities for certain services. For some services, your PCP may be required to obtain prior authorization from Innovation Health Medicare.
You must use network providers, except for:
- Emergency or urgent care situations
- Out‐of‐area renal dialysis
If you get routine care from out‐of‐network providers, Medicare and Innovation Health Medicare won’t be responsible for the costs.
If you’re enrolled in an Innovation Health Medicare Plan (PPO)
You have the flexibility to receive covered services from network providers or out‐of‐network providers. Out‐of‐network/non‐contracted providers are under no obligation to treat Innovation Health Medicare members, except in emergency situations. For a decision about whether we’ll cover an out‐of-network service, we encourage you or your provider to ask us for a pre‐service organization determination before you receive the service. Please call us or see your Evidence of Coverage for more information, including the cost share for out‐of‐network services.
Although you don’t have to choose a primary care physician, we encourage you to do so. If you receive covered services from an out‐of-network doctor, it’s important to confirm that they:
- Accept your PPO plan
- Are eligible to receive Medicare payment
