Locate a Provider
- Locate a Provider
Network of Preferred Providers
To locate participating network health providers, select from the links below. Or, contact us for assistance 24 hours a day, 7 days a week at 1-800-410-7778. Our representatives are happy to assist you.
Locate MHBP Network Health Providers
- Find Doctors, Hospitals, Labs and Facilities (Coventry National Network)
- QualCare Network (New Jersey)
- Medical Mutual of Ohio SuperMed PPO (Plus) Network (Ohio)
- Find a CVS Caremark pharmacy
- Find Quest Diagnostics Laboratories
- Find a Dentist - MHBP Dental Plan
- VSP Network Provider - MHBP Vision Plan
- Find EyeMed Providers
- Find a QualSight LASIK Provider
To receive In-Network benefits, you must contact the Plan before arranging to see a mental health provider. See the official Plan brochure or call us at 1-800-410-7778 for more information on your mental health benefits.
Accessing Providers in New Jersey and Ohio
If you are looking for participating providers in Ohio, please select the Medical Mutual of Ohio SuperMed PPO (Plus) Network link. If you are looking for MHBP providers in New Jersey, please select the QualCare link. For providers in all other states, you should use the Find Doctors, Hospitals, Labs and Facilities link.
Please read the Special Information for the New Jersey network for more information on using health care providers in this location.
About the MHBP Network Provider Search
Our fee-for-service plan offers services through a PPO. When you use our PPO providers, you will receive covered services at reduced cost. MHBP is solely responsible for the selection of preferred providers in your area. Continued participation of any specific provider cannot be guaranteed.
When you phone for an appointment, please remember to verify that the health care professional or facility is still a PPO provider. Network health providers may be more extensive in some areas than others.
We cannot guarantee the availability of every specialty in all areas. If no PPO provider is available, or you do not use a PPO provider, non-PPO benefits apply.
Please Note: If your provider does not currently participate in the Coventry National Network and you would like to have him/her considered for inclusion, please print the Provider Nomination Form and have your physician complete it and return it to us at the address noted on the form.
About Blended Rate Fee Schedules
MHBP is a fee-for-service Plan that allows you and your covered dependents to choose your medical service providers. However, when you choose an out-of-network/non-PPO provider, you may incur higher out-of-pocket expenses.
If you receive care in an area that has a fully developed PPO network (one in which you have adequate access to a network health insurance provider), but you do not use a PPO network provider the Plan’s allowance will be reduced to a rate that the Plan would have paid had you used a PPO provider.
This non-PPO allowance is based upon a fee schedule that represents an average of the PPO fee schedules for a particular service in a particular geographic area. In industry terms, this is called a “blended” fee schedule. Member out-of-pocket costs resulting from the application of the blended rate fee schedule will be limited to no more than an additional $5,000 (not including applicable coinsurance or copayments) beyond the out-of-pocket costs (not including applicable coinsurance or copayments) that would have been incurred if the blended rate had not been applied to the claim. This limitation on such additional out-of-pocket costs is applicable separately (per occurrence) to inpatient or outpatient hospital or ambulatory surgical center services and separately (per occurrence) to surgical fees. Other services to which the blended rate fee schedule applies are not subject to this limitation. We encourage you to call the Plan before scheduling any outpatient hospital or ambulatory surgical center services and/or surgery so that we may assist you, if possible, in avoiding situations where the blend rate fee schedule will be applied.
Note: For those members who do not have adequate access to a network health insurance provider (in terms of distance from where you receive care to a network provider) or those members receiving emergency care, the Plan’s non-PPO allowance will be based on the reasonable and customary charge (as described below), not the “blended” fee schedule.
If you receive care in an area that does not have a fully developed network, and use a non-PPO provider, the non-PPO allowance is the reasonable and customary allowance for your medical or mental health/substance abuse services based on the reasonable and customary charge. This is generally the lesser of either (a) the usual charge made by the provider for the service or supply in the absence of insurance or, (b) the charge that the Plan determines to be in the 80th percentile of the prevailing charges made for the service or supply in the geographic area in which it is furnished. The prevailing charge data is collected by the Plan’s underwriter. For certain services, exceptions to the general method of determining reasonable and customary may exist including the use of the National Correct Coding Initiative (NCCI).
If you receive services from a participating provider, the Plan’s allowance will be the amount that the provider has negotiated and agreed to accept for the services and or supplies. Benefits will be paid at non-PPO benefit levels, subject to the applicable deductibles and copayments. For more information, see Differences between our allowance and the bill in Section 4 of the Official Plan Brochure.
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