2024 Evidence of Coverage for UnitedHealthcare® Group Medicare Advantage PEBB Balance (PPO) Chapter 3: Using the plan for your medical services 63 · You receive your care from a provider who is eligible to provide services under Original Medicare. As a member of our plan, you can receive your care from either a network provider or an out-of-network provider (for more about this, see Section 2 in this chapter). - The providers in our network are listed in the Provider Directory. - Please note: While you can get your care from an out-of-network provider, the provider must be eligible to participate in Medicare. Except for emergency care, we cannot pay a provider who has opted out of or been excluded or precluded from the Medicare Program. If you go to a provider who is not eligible to participate in Medicare, you will be responsible for the full cost of the services you receive. Check with your provider before receiving services to confirm that they are eligible to participate in Medicare. Section 2 Using network and out-of-network providers to get your medical care As a member of the UnitedHealthcare® Group Medicare Advantage PEBB Balance (PPO) plan, you may see doctors and other health care professionals, medical groups, hospitals, and other health care facilities that are not contracted with UnitedHealthcare, as long as they accept the plan and have not opted out of or been excluded or precluded from the Medicare Program, and as long as the services are covered benefits and are medically necessary. Unlike most PPO plans, with this plan you pay the same cost share in-network and out-of-network. Section 2.1 How to get care from specialists and other network providers A specialist is a doctor who provides health care services for a specific disease or part of the body. There are many kinds of specialists. Here are a few examples: · Oncologists care for patients with cancer. · Cardiologists care for patients with heart conditions. · Orthopedists care for patients with certain bone, joint, or muscle conditions. How to access your behavioral/mental health benefit To directly access your behavioral/mental health benefits, please call the number on your UnitedHealthcare member ID card 24 hours a day, 7 days a week. When you call, you will speak with a representative who will check your eligibility and gather basic information about you and your situation. Depending on the help you need, a clinician may then talk with you about the problem you are experiencing and assess which provider and treatment would be appropriate for your situation. You may also ask your Primary Care Provider (PCP) to call the number on your UnitedHealthcare member ID card and arrange a referral on your behalf. You may also call to receive information about network practitioners, subspecialty care and obtaining care after normal office hours. Confidentiality is maintained, so please be assured that personal information you discuss with their staff will be kept strictly confidential.