What is the reimbursement policy for out-of-network services?

Health Choice's reimbursement policy for out-of-network services aims to provide members with flexibility while ensuring fair coverage. When seeking services outside our network, members may be eligible for reimbursement, subject to certain conditions. The reimbursement amount is determined by a reasonable and customary rate, based on industry standards and regional healthcare costs. Deductibles, coinsurance, and maximum limits apply, as outlined in each member's specific plan. To initiate the reimbursement process, members need to submit a claim form along with supporting documentation, such as receipts and itemized bills. Health Choice reviews these claims in a timely manner and typically issues reimbursements directly to the member. It is important to note that the reimbursement amount may not cover the full charges incurred for out-of-network services. Members are advised to review their plan details and contact customer service for further information on specific reimbursement policies.