In-Network Providers:  Ambetter contracts with health care professionals to provide our members with the full range of covered benefits, including primary care providers, specialists, telehealth providers, mental health and behavioral health providers, and hospitals. These providers of health care services are called in-network providers. Throughout the year, the providers available in-network may change. It is important that you check the provider search engine for the latest information on whether the provider you are planning to see is in-network.* If you discover an error in the provider search engine results, or if a provider listed in the search engine results tells you that they do not accept our insurance or are not taking new patients, please promptly report the matter to us through the “suggest an edit” feature in the search engine or by contacting Member Services, so we can address the matter. Because most providers and facilities are independently owned and operated, we do not control their schedules and cannot control when they may be able to see you, and they may not update us when their availability or other information changes. As a result, it may be necessary for you or us to contact multiple network providers to find one that can see you on the schedule that works for you, in consultation with your network Primary Care Physician. If you need assistance or would like our help finding an available network provider, please contact Member Services, which is available to help. Member Services can be contacted at the phone number on the back of your Ambetter Member ID Card or through your account online.

Out-of-Network Providers:  If a provider does not accept Ambetter insurance, they are referred to as out-of-network. If you receive non-emergency services from an out-of-network provider, you may be responsible for the entire cost of the medical bill, unless otherwise required by state or federal regulations. To take full advantage of your Ambetter coverage, it is important to only use in-network providers. For more information, please review your Evidence of Coverage (EOC) or contact Member Services.

* When receiving care at an in-network Ambetter hospital, some hospital based providers may not be in-network. For example, you may receive services from anesthesiologists, radiologists, pathologists, or emergency service providers that are not contracted with Ambetter. While an in-network hospital’s emergency department may be contracted with Ambetter, the providers within the department may not be. As a result, these out-of-network hospital based providers may bill you for the difference between what Ambetter pays them and their total bill – this is known as surprise “balance billing.” We encourage you to ask providers if they participate with Ambetter before they treat you, so you know whether or not you may receive a bill for their services. For more information, contact Member Services. If you do receive a surprise balance bill please contact the customer service number on your Member ID card so we can assist you in resolving the issue.