content top new


Out-of-Network Service

From time to time a Member may want to use a non-network provider. The Premier Plan provides coverage for Out-of-Network service. However, this type of service generally will result in a higher cost to the Member and the Plan for the following reasons:

  • Not only will the Member have to pay the deductible and coinsurance identified and itemized in the Premier Plan Benefits Summary, but the provider’s charges will generally be higher because those charges generally are not discounted.
  • If the provider’s charges exceed the reasonable and customary charge for the procedure, the Plan will not consider this excess cost in calculating its reimbursement and the Member will have to pay this additional cost.
  • In-Network providers generally follow medical procedures which have been certified as effective by the provider’s Medical Board.
  • If you use an Out-of-Network pharmacy, you may incur additional expenses because MILA will reimburse you for no more than it would have paid the highly discounted In-Network pharmacies for each drug. See page 40 for more information.
  • You will be responsible for ensuring that your provider follows all Plan medical management procedures in precertifying your care, your hospitalization or other institutional care and in securing any necessary prior authorization for prescription drugs.

You should attempt to use In-Network providers whenever possible in order to be assured of receiving the highest quality medical service at the lowest possible cost to you and your family.