Out of Network Coverage (Part C)

Out-of- Network Coverage

Most of the time, you must get care from a Superior HealthPlan provider. There are some times when network providers may not be close to your area. Those times are:

  • In an emergency
  • When urgent care is needed that you cannot get from network provider
  • When care is needed that cannot be offered by a network provider
  • Continuity of care.
  • Kidney dialysis services when you are outside the plan’s service area

Your primary care provider or Superior HealthPlan needs to approve the service. Without an approval, you will have to pay for the service.

In some cases your doctor may send you to an out-of-nework doctor. Your doctor will need to get prior approval from the health plan.

Some of these reasons may be because:

  • Services are not available in network as soon as you need them
  • Your doctor decides that an out-of-network doctor would be better for the member.

See your Member Handbook for more information.

For more information, call Member Services at 1-866-896-1844. Hours are 8 a.m. to 8 p.m., Monday through Friday. After hours, on weekends and on holidays, you may be asked to leave a message.  Your call will be returned the next business day. TTY users call 711.

Last Updated: 10/01/2016