Out of Network Coverage (Part C)

In most cases, you must receive your care from a Michigan Complete Health (MMP) doctor. There are some times, when the care you receive from an out-of-network provider will be covered. Those times are:

  • Emergency care or urgent care.
  • When care is needed that cannot be offered by a network provider.
  • Continuity of care
  • Kidney dialysis services that you get at a Medicare-certified dialysis facility when you are temporarily outside the plan’s service area.
  • The plan covers out-of-network care in unusual circumstances, so long as those services are authorized in advance by Michigan Complete Health (MMP).

Circumstances that may lead to out-of-network care are:

  • You have a rare medical condition and the services are not available from network providers.
  • Services are available in-network but are not available as soon as you need them.
  • Your doctor decides that a non-network provider would better serve you. Without an authorization, you will have to pay for the service.

See the Benefits Chart in your Member Handbook.

If you have any questions, call Member Services at 1-844-239-7387. Hours are from 8 a.m. to 8 p.m., seven days a week. TTY users call 711. On weekends and on state or federal holidays, you may be asked to leave a message. Your call will be returned within the next business day

Last Updated: 09/30/17
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