Out of Network Coverage (Part C)

In most cases, you must receive your care from a Buckeye Health Plan provider. There are some times when network provider may not be offered or nearby. Those times are:

  • In an emergency
  • When urgent care is needed that you cannot get from a 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.

In some cases your doctor may send you to an out-of-network doctor. Your doctor will need to get prior approval from the health plan. Some of those times may be because:

  • You have a rare medical condition and the services are not available from network providers.
  • Services are not available in-network as soon as you need them.
  • Your doctor decides that a non-network provider would be better for you.

See the Benefits Chart in your Summary of Benefits.

For more information, call our Member Service number at 1-866-549-8289. Hours are from 8 a.m. to 8 p.m., Monday through Friday. On weekends and on holidays, you may be asked to leave a message. Your call will be returned within the next business day. TTY users call 711.

Last Updated: 09/30/2017