Member Responsibility

If the Procedure Code Description for any claims says “Non-Network”, this means the provider is not in our network. Your in-network doctor or hospital may use an out-of-network provider for some services; however, you should not be billed by out-of-network providers for emergency services any amount over your cost share amount (including deductible, copay and/or coinsurance). If you are billed by an out-of-network provider for covered emergency services in an amount greater than your cost share amount, then contact our member services team at 1-877-687-1189 (TTY/TDD 1-877-941-9236).­­

The “Out of Pocket Costs” and “Member Cost Share” represent your deductible, copay and/or coinsurance, but not any charges denied as member responsibility. In cases where a claim line is denied for a reason that is your responsibility, such as not being eligible on the date of service, or obtaining non-emergent services at a non-network provider without proper authorization, you may be billed for such denials.