As a HealthTeam Advantage PPO member, you can receive care from any provider or hospital you choose. You do not need a referral to any doctor or hospital. We encourage you to select an in-network provider to act as your Primary Care Provider (PCP). The term PCP will be used throughout this directory. When you select a HealthTeam Advantage in-network PCP, you’ll have a dedicated physician who will focus on your individual health care needs and coordinate your care with other in-network providers if needed. This allows you to keep your out-of-pocket costs lower and more predictable.

The network providers listed in this directory have agreed to provide you with your health care and vision coverage. You may go to any of our network providers listed in this directory. If you have been going to one network provider, you are not required to continue going to that same provider. In some cases, you may get covered services from non- network providers.

Out-of-network/non-contracted providers are under no obligation to treat HealthTeam Advantage members, except in emergency situations. For a decision about whether we will 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 your healthcare concierge or see your Evidence of Coverage for more information, including the cost sharing that applies to out-of-network services.

If you select an out-of-network provider, please make sure the provider accepts Medicare; otherwise, you may have to pay more for their services. If an out-of-network provider submits a bill directly to you, do not pay the bill. Instead, submit it to HealthTeam Advantage for processing and determination of enrollee liability, if any. With the exception of emergencies or urgent care, it may cost more to get care from out-of-network providers.

You do not need to get a referral or approval in advance when you get care from out-of-network providers. However, it is strongly recommended that you provide notification to HealthTeam Advantage before you get some services from non-plan providers. If you do not provide this notification, you may be responsible for the providers’ charges, if HealthTeam Advantage determines the services are not covered benefits, or are not medically necessary. If you provide notification before obtaining services, you will not run the risk of HealthTeam Advantage determining that the services are not covered.

2024 PROVIDER AND PHARMACY DIRECTORY

If you need emergency care, you are covered 24 hours a day, 7 days a week, anywhere in the world whether you are in or out of HealthTeam Advantage’s service area. Call 911 or go to the nearest emergency facility. Emergency care can always be obtained in or out of the service area from the nearest available provider.

Post-stabilization care is medically necessary services related to your emergency medical condition that you receive after your treating physician determines that your condition is clinically stable. All in-network and out-of-network follow-up care will be covered under the terms and conditions of your plan.