Out of Network Coverage
Alterwood Advantage is a Health Maintenance Organization (HMO) meaning member must see network providers for covered services. There are three (3) exceptions to this:
- Emergency care or urgently needed services when network providers are temporarily unavailable or inaccessible.
- Medical care that Medicare requires our plan to cover and the providers within our network cannot provide this care (Authorization must be obtained from the plan prior to seeking this care).
- When temporarily outside of the Alterwood Advantage service area, the plan covers kidney dialysis services through a Medicare-certified dialysis facility.
Please refer to your Evidence of Coverage for more information, including the cost-sharing that may apply if you see out of network providers. If you have further questions, please contact our Member Services team:
Call 667-262-9412 or 1-866-675-3944 toll-free (TTY: 711)
8 am – 8 pm ET | 7 days a week | October 1 – March 31
8 am – 8 pm ET | Monday – Friday | April 1 – September 30