As a plan member, you can choose to receive care from out-of-network providers. Your plan will cover services from either in-network or out-of-network providers, as long as the services are covered benefits and medically necessary.
You may use any provider that accepts Medicare. The amounts you pay for covered services out-of-network accumulate toward a combined maximum out-of-pocket amount for both in-network and out-of-network providers. Once you have reached your combined maximum out-of-pocket amount, you will have 100% coverage and will not have any out-of-pocket costs for the rest of the year for covered Part A and Part B services.
Call the Member Services number on the back of your ID card for more information — including details on out-of-network service cost-sharing. You can learn more in your plan's Evidence of Coverage or Summary of Benefits documents.
Contact us
North Dakota and South Dakota
October through March are M-Sun 8am-9pm
Out-of-network/non-contracted providers are under no obligation to treat plan members, except in emergency situations. Please call Member Services or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.
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Last updated: October 2024