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 in-network providers and who are referral only providers. 

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

The health care providers in-network can change at any time. You may also request information regarding MAHP in-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 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 in-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 in-network provider will arrange for necessary referral care by notifying MAHP.  MAHP recommends that referral requests come from an in-network provider with similar or same specialty. The referral section of the Plan Provider Directory lists providers who require authorization.

In-Network:

• Referral requests must be made by an in-network provider to MAHP. MAHP recommends that referral requests come from an in-network provider with similar or same specialty. For referral services to be eligible and covered by MAHP, the referral must be authorized by the MAHP Medical Director.
• After 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, then MAHP cost sharing will apply)