A contractual provision by which members are required to use certain health care providers in order to receive coverage (except in cases of urgent or emergent need).
A requirement under which all covered services, except Emergency Services, Urgently Needed Services or Out-of-Area Kidney Dialysis, must be provided or authorized by your Contracted Medical Provider or your PCP. All health care must be arranged or provided by network providers or authorized by AdvantageCare. This requirement includes inpatient or outpatient hospital facilities. If you get any other services from a Non-Contracted Medical Provider or a contracted provider such as a Specialist without prior authorization, neither AdvantageCare nor original Medicare will pay for such services.
A contractual provision by which members, except in cases of unforeseen out-of-area urgently needed care or emergency care, are required to receive all their care from the managed care plan's network or health care providers.