Information Last Updated: 1/17/2019
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With limited exceptions, while you are a member of our plan you must use network providers to get your medical care and services. Most of your care may likely be performed by your Primary Care Physician (PCP). When you need other services like seeing a specialist, getting tests, or getting surgical procedures, your PCP will request those services in advance and get approval so the health plan will pay for all or much of the costs.
There are some exceptions when Brand New Day covers out-of-area services:
If you need a specialist that is not in your local contracting network, Brand New Day will arrange for services with a non-contracting specialist to ensure there is no delay in getting you the care you need. These services need to be arranged in advance.
Please refer to Chapter 3 your Evidence of Coverage for full information on out-of-network medical coverage.