Ambetter contracts with providers for the full range of covered benefits. These providers are called in-network providers. Throughout the year, the providers available in-network may change. It is important that you review the provider directory for the latest information on whether or not the provider you are planning to see is in-network.* If a provider does not accept Ambetter insurance, they are referred to as out-of-network. If you receive non-emergency services from an out-of-network provider, you may be responsible for the entire cost of the medical bill, unless otherwise required by state or federal regulations. To take full advantage of your Ambetter coverage, it is important to only use in-network providers. For more information, please review your Evidence of Coverage (EOC) or contact Member Services.
* When receiving care at an in-network Ambetter hospital, some hospital based providers may not be in-network. For example, you may receive services from anesthesiologists, radiologists, pathologists, or emergency service providers that are not contracted with Ambetter. While an in-network hospital’s emergency department is contracted with Ambetter, the providers within the department may not be. As a result, these out-of-network hospital based providers may bill you for the difference between what Ambetter pays them and their total bill – this is known as surprise “balance billing.” We encourage you to ask providers if they participate with Ambetter before they treat you, so you know whether or not you may receive an additional bill for their services. For more information, contact Member Services. If you do receive any Surprise Balance Billing please contact the customer service number on your Member ID card so we can assist you in resolving any surprise balance billing.
