Senior Care Options out-of-network coverage
How to Get Care from Out-of-Network Providers
You should get care from providers in the Commonwealth Care Alliance® (CCA) network. In some situations, we cover care from providers outside our network.
You are covered for emergency room (ER) visits. This includes hospitals that are in or out of the network.
In some cases, Medicare or MassHealth (Medicaid) requires the plan to cover certain types of care. If that care is not available from a network provider, we will cover care from an out-of-network provider and an unlimited annual maximum. Your primary care provider must approve the care before you get it. Also, CCA must have a signed agreement with the out-of-network provider.
We cover kidney dialysis services at a Medicare-certified dialysis facility when you are temporarily outside the plan’s service area.
Examples include:
- You have a unique medical condition and the service is not available from a network provider.
- You need care sooner than a network provider can provide it.
For more information about out-of-network coverage, see your Member Handbook.
The benefit information provided here is a brief summary, not a complete description of benefits. Benefits, formulary, and pharmacy and/or provider networks may change on January 1 of each year. Limitations, copayments, and restrictions may apply. You will be covered for all services listed above as long as they are approved and/or coordinated by your primary care provider, your care team, or Commonwealth Care Alliance (CCA). For more information, call CCA Member Services or read your Member Handbook.
