In-Network Providers

We offer network and emergency care options.

In-Network

You must use in-network providers of the plan you are enrolled in for health care services, except in an emergency or urgent situation. Please refer to your plan Provider Directory to see who are network providers.

If you go to a non-network provider and it was not an emergency or an authorized referral, only Original Medicare will pay, and Medicare cost sharing would apply (except for Freedom Plan, as applicable MAHP cost sharing will apply).

The health care providers in the network can change at any time. You may also request information regarding network provider, such as his or her training, title, or specialty. For the most up-to-date information on the network of providers of your plan, check our website or call our Member Services Department. 

Urgent and Emergency Care

Out of Service Area

Urgent and Emergency services are covered for Medicare eligible services worldwide.  If you experience an illness or injury of an urgent or emergency nature when away from the area and treatment cannot be postponed until you get home, you are still covered. 

Go to the nearest facility to receive care, and after you receive care, you should notify MAHP within 48 hours.  Please call the toll-free number listed on the back of your ID card. 

Within Service Area

If you are within the service area and need urgent or emergency services, you should contact your network provider unless you feel doing so may endanger your health.  If you have a serious medical concern, go immediately to the emergency room of a hospital.  If you have a non-life threatening medical concern, you can utilize an in-network Urgent Care Center.

Second Opinion/Referral Care

If medical services are not available within the network or if you need a second opinion, your network provider will arrange for necessary referral care by notifying MAHP.  MAHP recommends that referral requests come from a network provider with a similar or the same specialty. 

In-Network:

• Referral requests must be made by a network provider to MAHP, and the referral requests come from a network provider with a similar or the same specialty. For referral services to be eligible and covered by MAHP, the referral must be authorized by MAHP and/or the Medical Director.
• After the referral request is received and reviewed, you will receive either:
  • an authorization approval letter for the referral appointment listing the date of the referral appointment and referral provider, along with the level of authorization for which the appointment is approved as:
    • Consultation only;
    • Consultation and/or testing; or
    • Consultation, testing and/or treatment
    • a denial letter with appeal rights
    • An authorized referral is needed for each appointment.
    • If the original approved referral appointment date is changed, MAHP needs to be notified.

Out of Network:

• No authorization required
• Original Medicare cost sharing (unless Freedom Plan, as MAHP cost sharing will apply)