Non-Plan Providers Say the Darndest Things
Posted on April 30, 2012
Sometimes, non-plan providers tell our members that they accept HNE insurance. This “acceptance” can be misleading and can mean different things to the parties involved. Often, to the member it means the provider is contracted with HNE. The member assumes that the services they are about to receive will be covered. To the non-plan provider it means they are willing to bill HNE even if they are not a contracted provider. In the latter case, the claim will most likely be denied as not authorized. The non-plan provider will then bill the member for the services. Most HNE members have an HMO policy, which limits coverage of non-emergent services to the HNE network. Therefore, it is important to know if a provider is in-plan or out-of-plan (not contracted with HNE).
HNE therefore recommends that members contact HNE directly if they have a question about whether a provider is in-plan or not. By contacting the HNE Member Services Department, you are sure to get the most up-to-date and accurate information about a provider. The HNE Member Services Department is available Monday through Friday from 8 a.m. to 5 p.m. Their telephone number is 413.787.4004 or 800.310.2835. In the event you can’t call the HNE Member Services Department, you may also search for in-plan providers at HNE.com. We also have a new mobile app that lets you search our provider directory with your smart phone. Just go to hne.com/mobile to download the free HNE Member Mobile App.
HNE members can and do receive services from non-plan providers. However, unless pre-approved by HNE, services from non-plan providers, with the exception of emergency services, will not be covered. If services with a non-plan provider are ever needed, your primary care provider or other in-plan provider must submit a prior authorization request form to HNE’s Health Services Department. HNE will then notify you and your referring provider in writing of our decision.
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