What Happens if Your Provider is Out-of-Network?
Having a reliable provider is beneficial to your healthcare. When you’ve found the provider who meets your needs, HealthTeam Advantage (HTA) values your choice, even if they’re out-of-network.
While we have an extensive provider network, we recognize you may be referred to a specialist, prefer an out-of-network doctor, or need medical attention when you’re out of town. Regardless of the reason, PPO members receive all plan benefits whether the provider is in- or out-of-network. The benefit to seeing in-network providers is lower out-of-pocket costs since in-network providers have negotiated rates with HTA.
If you see an out-of-network provider, they are not required to file your claims. If they don’t, you will likely be required to pay at the time of service and file a Direct Member Reimbursement with us.
You can find the Direct Member Reimbursement Requests online (medical, dental, vision) or you can contact your Healthcare Concierge by email or phone at 888-965-1965. They’ll be happy to help!