Out-of-Area Student Coverage

Posted on June 11, 2014

At HNE, we support the desire of young people (and others) to gain a higher education. Here’s how we can help.

For members enrolled in HMO plans, dependents attending and residing at school outside of HNE’s service area are covered for the following items:

• Emergency or Urgent Care Visit (call HNE after an Urgent Care visit)
• Follow-up Visit After an ER or Urgent Care Visit
• Non-routine Medical Office Visit (includes Diagnostic Lab and X-Ray)
• Allergy Injections
• Outpatient Short-Term Rehabilitation Services

For members enrolled in non-HMO plans with an out-of-network benefit, these services are covered at the out-of-network benefit level.

Outpatient Behavioral Health Visits

For outpatient behavioral health visits, out-of-plan providers must fax information to the Behavioral Health Department (fax 413.233.2800) on company letterhead.

The information in the fax must include:

• A statement that the member is a college student
• Member’s name, date of birth, and HNE ID #
• Provider’s credentials or licensure
• Provider’s Tax ID #
• Student’s demographics
• Intake date
• Billing codes for treatment

Once the information is received, HNE will authorize 20 visits. If the member needs more than 20 visits, the provider can submit a treatment form for review

This process is not applicable for Be Healthy members. Services for Be Healthy members are available through the Massachusetts Behavioral Health Partnership (MBHP).

All services require prior approval by HNE.

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