You do not need a referral or prior authorization for
urgent or emergency services — no matter where you travel:
- Prevea360 Health Plan covers urgent and emergency services while you are outside of our service area (subject to member policy copays, coinsurance, deductibles and maximum allowable fees).
- Out-of-network services are from doctors, hospitals and other health care professionals that have not contracted with your plan.
- Depending on the health care professional, the service could cost you more or not be paid for at all by your plan, which means you will be charged the full amount. Charging you this extra amount is called balance billing.
Care received by an out-of-network provider is covered under these circumstances:
EMERGENCY SERVICES
- Emergency Services received from an out-of-network provider if the member cannot reach an in-network provider.
- All follow-up care should be done by a plan provider. If you are out of the area and unable to see a plan provider, call your primary care provider for a referral to an out-of-network provider. These services require approval by Prevea360 Health Plan.
URGENT CARE SERVICES
- If you receive out-of-network urgent care services, you are covered by your plan for charges up to the maximum allowable fee. If there is a difference between the maximum allowable fee and what the out-of-network provider bills, you may have to pay the difference.
- Call our Customer Care Center at 877-230-7555 if you have questions about the maximum allowable fee.
