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Out-of-Network Coverage (Part C)

In most cases, you must receive your care from a Buckeye Health Plan – MyCare Ohio (Medicare-Medicaid Plan) provider. There are some exceptions, however, when care you receive from an out-of-network provider will be covered. Those exceptions are:

  • Emergency care or urgently needed care that you get from an out-of-network provider
  • If you need care that cannot be adequately provided by a network provider, including need for continuity of care, you can get this care from an out-of-network provider.
  • Kidney dialysis services that you get at a Medicare-certified dialysis facility when you are temporarily outside the plan’s service area
  • The plan covers out-of-network care in unusual circumstances, so long as those services are authorized in advance by your primary care provider or Buckeye Health Plan – MyCare Ohio (Medicare-Medicaid Plan). Please remember that without that authorization, you will be responsible for payment of the service.

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 unique medical condition and the services are not available from network providers.
  • Services are available in-network but are not available as soon as you need them
  • Your primary care provider determines that a non-network provider can best provide the service.

See the Benefits Chart in your Summary of Benefits.

For more information, please refer to your Member Handbook or call Member Services at 1-866-549-8289. 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.

Out-of-Network Coverage

In most cases, you must receive your care from a Buckeye Health Plan – MyCare Ohio (Medicare-Medicaid Plan) provider. There are some exceptions, however, when care you receive from an out-of-network provider will be covered. Those exceptions are:

  • Emergency care or urgently needed care that you get from an out-of-network provider
  • If you need care that cannot be adequately provided by a network provider, including need for continuity of care, you can get this care from an out-of-network provider.
  • Kidney dialysis services that you get at a Medicare-certified dialysis facility when you are temporarily outside the plan’s service area
  • The plan covers out-of-network care in unusual circumstances, so long as those services are authorized in advance by your primary care provider or Buckeye Health Plan – MyCare Ohio (Medicare-Medicaid Plan). Please remember that without that authorization, you will be responsible for payment of the service.

 Examples of unusual circumstances that may lead to out-of-network care are:

  • You have a unique medical condition and the services are not available from network providers.
  • Services are available in-network but are not available as soon as you need them
  • Your primary care provider determines that a non-network provider can best provide the service.
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Last updated: 10/01/2024
Material ID: H0022_WEBSITE_2025_Approved_10072024

Buckeye Health Plan - MyCare Ohio (Medicare-Medicaid Plan) is a health plan that contracts with both Medicare and Ohio Medicaid to provide benefits of both programs to enrollees.

This is not a complete list. The benefit information is a brief summary, not a complete description of benefits. For more information contact the plan or read the Buckeye Member Handbook.

Out-of-network/non-contracted providers are under no obligation to treat Buckeye members, except in emergency situations. Please call our Member Services number or see your Member Handbook for more information, including the cost-sharing that applies to out-of-network services.

Other pharmacies/physicians/providers are available in our network.

If you need help finding a network provider and/or pharmacy, please call 1-866-549-8289 (TTY: 711) or visit mmp.buckeyehealthplan.com to access our online searchable directory. If you would like a Provider/Pharmacy Directory mailed to you, you may call the number above, request one at the website link provided above, or email OH_MMP_EmailRequests@centene.com.

ATTENTION: If you speak English, language assistance services, free of charge, are available to you. Call 1-866-549-8289 (TTY: 711) from 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 within the next business day. The call is free.

ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-866-549-8289 (TTY: 711) de 8 a. m. a 8 p. m., de lunes a viernes. Luego del horario de atención, los fines de semana y los días feriados, es posible que se le pida que deje un mensaje. Le devolveremos la llamada durante el próximo día hábil. La llamada es gratis.


Last updated: 10/01/2024
Material ID: H0022_WEBSITE_2025_Approved_10072024

Buckeye Health Plan - MyCare Ohio (Medicare-Medicaid Plan) is a health plan that contracts with both Medicare and Ohio Medicaid to provide benefits of both programs to enrollees.

This is not a complete list. The benefit information is a brief summary, not a complete description of benefits. For more information contact the plan or read the Buckeye Member Handbook.

Out-of-network/non-contracted providers are under no obligation to treat Buckeye members, except in emergency situations. Please call our Member Services number or see your Member Handbook for more information, including the cost-sharing that applies to out-of-network services.

Other pharmacies/physicians/providers are available in our network.

If you need help finding a network provider and/or pharmacy, please call 1-866-549-8289 (TTY: 711) or visit mmp.buckeyehealthplan.com to access our online searchable directory. If you would like a Provider/Pharmacy Directory mailed to you, you may call the number above, request one at the website link provided above, or email OH_MMP_EmailRequests@centene.com.

ATTENTION: If you speak English, language assistance services, free of charge, are available to you. Call 1-866-549-8289 (TTY: 711) from 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 within the next business day. The call is free.

ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-866-549-8289 (TTY: 711) de 8 a. m. a 8 p. m., de lunes a viernes. Luego del horario de atención, los fines de semana y los días feriados, es posible que se le pida que deje un mensaje. Le devolveremos la llamada durante el próximo día hábil. La llamada es gratis.