Locate a Provider
- Locate a Provider
Network of Participating Providers
To locate participating Network 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
Please note: MHBP medical provider networks will change for 2014 in certain states. If you use providers in these 13 states: AZ, CA, DC, FL, GA, NC, NJ, NY, OH, SC, TN, TX and VA, you will access Aetna Choice POS II, and for all other locations you will access the Coventry National Network same as before. As we transition, the Coventry National Network directory may include providers in the states that should be accessed through Aetna Choice POS II; therefore, it is very important to choose the network that corresponds to when and where you need care.
Search 2014 Providers: Use the links specified below to find providers you may wish to visit in 2014. If you are looking for providers in one of the 13 states mentioned above, choose the link that shows "Aetna Choice POS II" and the state abbreviation. For any other state, please choose the link that includes "Coventry National Network for all other states" to locate providers. Please be sure to select the correct link and only search for providers in locations as the link specifies. Otherwise, once in the search tool, you will need to select "start a new search" and select "change plans" to select the correct network for your search.
- Find Doctors, Hospitals, Labs and Facilities in Aetna Choice POS II- AZ, CA, DC, FL, GA, NC, NJ, NY, OH, SC, TN, TX and VA
- Find Doctors, Hospitals, Labs and Facilities in Coventry National Network for all other states not shown above
Search 2013 Providers: Use the links specified below to find providers you may wish to visit in 2013. Also note that effective January 1, 2014, you will no longer have access to the QualCare network in New Jersey or the MMO SuperMed network in Ohio. You will use Aetna Choice POS II in these and certain other locations as indicated above. Many of the providers you use today and more are available through Aetna Choice POS II. You may use the Aetna Choice POS II link to verify if your provider continues to participate with us. If you need help locating providers, please contact us at 1-800-410-7778.
- Find Doctors, Hospitals, Labs and Facilities (Coventry National Network) --valid for care provided in 2013 (OH & NJ use links below)
- QualCare Network (New Jersey) --valid for care provided in 2013
- Medical Mutual of Ohio SuperMed PPO (Plus) Network (Ohio) --valid for care provided in 2013
Find other types of providers (to be used anytime):
- 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 Network benefits, you must contact the Plan before arranging to see a mental health provider. These providers are typically not included in the online provider directory. See the official Plan brochure or call us at 1-800-410-7778 for more information on your mental health benefits.
About the MHBP Network Provider Search
Our fee-for-service plan offers services through a provider Network. When you use our Network providers, you will receive covered services at reduced cost. MHBP is solely responsible for the selection of Network 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 participating Network 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 Network provider is available, or you do not use a Network provider, non-Network benefits apply.
Please Note: If your provider does not currently participate in the 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 Non-Network provider, you may incur higher out-of-pocket expenses.
Non-Network allowance: the amount the Plan will consider for services provided by Non-Network providers. Non-Network allowances are determined as follows:
For all dialysis services and all urine drug testing services, the Non-Network allowance is the maximum Medicare allowance for such services.
For other than dialysis services and urine drug testing services, the following applies:
If you receive care in an area that has a fully developed Network (one in which you have adequate access to a network provider), but you do not use a Network provider the Plan’s allowance will be reduced to a rate that the Plan would have paid had you used a Network provider. This Non-Network allowance is based upon a fee schedule that represents an average of the Network 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 blended rate fee schedule will be applied.
Note: For those members who do not have adequate access to a Network provider (in terms of distance from where you receive care), those members receiving emergency care, or where there is no “blended” fee schedule amount for the service or supply, the Plan’s Non-Network allowance will be based on the Plan’s out-of-network (OON) fee schedule (as described below), not the “blended” fee schedule.
If you receive services from a participating provider (see Other Participating Providers, page 10), 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-Network benefit levels, subject to the applicable deductibles, coinsurance and copayments.
If you receive care in an area that does not have a fully developed network and use a Non-Network provider, the Non-Network allowance is the lesser of: (1) the provider’s billed charge; or (2) the Plan’s OON fee schedule amount. The Plan’s OON fee schedule amount is equal to the 80th percentile amount for the charges listed in the Prevailing Healthcare Charges System or the Medicare Data Resources System administered by FAIR Health, Inc. if such a charge exists for the service or supply. If no FAIR Health charge exists, the OON fee schedule amount may be determined by using the iSight rate established by National Care Network. The OON fee schedule amounts vary by geographic area in which services are furnished.
For certain services, exceptions may exist to the use of the OON fee schedule to determine the Plan’s Non-Network allowance, including, but not limited to, the use of Medicare fee schedule amounts. For claims governed by OBRA ’90 and ’93, the Plan allowance will be based on Medicare allowable amounts as is required by law. For claims where the Plan is the secondary payor to Medicare (Medicare COB situations), the Plan allowance is the Medicare allowable charge.
Please refer to Section 10 of the official Plan brochure for complete details.
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