Understanding Your Out-of-Network Benefits

Some MHN benefit plans cover services received from out-of-network providers; others do not. (For details about your benefits, including copayments, deduct­ibles and exclusions, please refer to your Certificate of Insurance or Summary Plan Description or contact MHN or your benefits manager.)

Even if your plan includes out-of network coverage, there are many benefits to choosing an MHN network provider. One of those benefits is that your out-of-pocket costs are almost always lower when you use an in-network provider because:

  • Network providers have agreed to a fee schedule, and for covered services you will only be charged your pre-determined copayment.
  • Out-of-network providers are not bound by a fee schedule and can charge whatever they like. Your benefit is based on Maximum Allowable Amounts (MAA) or Usual, Customary and Reasonable (UCR) rates. These amounts are usually less than the provider's billed amount, and out-of-network providers can charge you for the difference.
  • If services received from a provider are later determined to be not medically necessary, out-of-network providers may charge you. (MHN network providers may not.)