We encourage our participating providers to send members to other in-network providers — when available and appropriate — to meet the member’s medical needs.
Members can choose from a variety of EmblemHealth and ConnectiCare networks. Many of our benefit plans limit coverage to in-network services. Even when out-of-network care is covered, members can benefit by using in-network providers to keep their costs down.
Our provider agreements and administrative guidelines generally require non-emergent/non-urgent care to be delivered by participating providers unless one is not available with the skills needed or is not available within a reasonable distance from the member’s home.
In cases where a participating provider is unavailable, as well as for continuity and transitional care needs, our Utilization Management team will review the non-participating provider’s request and make a determination. Preauthorization requests and supporting documentation may be submitted through our provider portals (emblemhealth.com/providerportal and connecticare.com/providerportal).
JP 64940 03/2024
