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Using your out-of-network PPO benefits

Your Devoted Health PPO plan has a network of trusted doctors, hospitals, and other providers in your area. To find an in-network provider, search our provider directory — or give us a call at 1-800-338-6833 (TTY 711). 

But you don’t have to limit yourself to this network. With a PPO plan, you can get medical care from out-of-network doctors, hospitals, and other providers, as long as they take Original Medicare and agree to see Devoted Health members. There are just a few things to keep in mind:

  • You can only see out-of-network providers who take Original Medicare and agree to see Devoted Health members. Many out-of-network providers will bill us directly, but in some cases, you may need to pay upfront and ask us to pay you back. See below for details. 
  • In some cases, your copay or coinsurance may be higher for out-of-network care. Check your plan documents to find out when you’ll pay more. 
  • Extra benefits may work differently. Everything we explain below is only for medical care. Extra benefits like fitness or hearing aids each have their own rules. See your plan documents for details. 
  • If you have a Dual Eligible Special Needs Plan (D-SNP) — and Medicaid normally pays your cost shares — it’s important that your out-of-network providers take Medicaid. If they don’t, you may have to pay the full cost share.

Are you an out-of-network provider? Learn how to bill Devoted Health at devoted.com/providers or see this provider flyer for details.

Can I really see any provider I want? 

If you need care right away, you can see anyone in-network or out-of-network. Costs are always the same for emergency care. And if you’re traveling outside your plan’s service area, costs are also the same for urgently needed care and for dialysis. 

Non-emergency care is a little different. Because out-of-network providers don’t have a contract with Devoted Health — and they may not know who we are! — you could run into some confusion. It’s best to make sure everyone’s on the same page before you make an appointment. Here’s what to ask:

  • Do you take Original Medicare? Your PPO plan will only cover care from providers who take Original Medicare. 
  • Will you accept payment from my Devoted Health PPO plan? Providers can bill us through our electronic systems, or with the same paper forms they use to bill Original Medicare. If they have questions, they can visit devoted.com/providers or call our provider line at 1-877-762-3515. 
  • If you’re a D-SNP member and Medicaid normally pays your cost share, also ask: Do you take Medicaid? If the provider doesn’t take Medicaid, you can still see them, but you may have to pay the full cost share.

If the provider answers “yes” to these questions, you can see them! There’s just one more thing to check. We can only pay for services if they're medically necessary and your plan covers them — so to avoid any surprises, we recommend that you or the provider check with us first. 

What if my provider won’t accept payment from Devoted Health?

You may still be able to see them — but it’s a bit more complicated. If they agree to see you, you’ll need to pay upfront and send us a detailed receipt that lists each service you got and what it costs. Then we’ll pay you back for the amount your plan covers. See devoted.com/paymeback for details. 

We don’t recommend doing this, because you may have to pay a lot of money upfront. And if there are any problems with the claim (for example, if some of the services you got aren’t covered), you could end up being responsible for some or all of the cost. 

What if I’m traveling to another state? 

You can use your out-of-network PPO benefits anywhere in the country — just keep in mind everything we’ve discussed above. And remember that non-emergency care outside your home state may be out-of-network — even if you see a Devoted Health provider. For example, if you live in Ohio, you’ll pay your out-of-network copay or coinsurance to see Devoted Health doctors in Florida.

Out-of-network/non-contracted providers are under no obligation to treat Plan members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.