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New commercial policy to go into effect Feb. 1, 2019

12/26/2018

The following policy will go into effect Feb. 1, 2019, for our commercial plans:

This policy — which providers are required to follow after Feb. 1, 2019 — tries to make sure our members are given advance notice before they receive care or services from an out-of-network physician, facility and/or other health care provider that may lead to higher out-of-pocket costs for the members. This policy won’t apply to emergency situations or when providers or the member received preauthorization from us to obtain care and/or services to use an out-of-network provider.

Under this policy, members will need to acknowledge they have been notified about and agree to using out-of-network providers by signing this Non-Participating Advance Member Notification Form. A copy of this signed form should be given to the member and a copy must be retained in the provider’s records.