Summary of Coverage and Cost Information for Out-of-Network Treatment

Disclosures to Covered Persons Regarding Out-of-Network Treatment

This summary provides an overview of how your health plan covers out-of-network treatment. It is provided as guidance only and does not alter your coverage in any way.

Resources

For more information about your in- and out-of-network benefits and costs for in-network treatment, please refer to your individual policy, group policy, certificate/evidence of coverage (if you have an employer group plan), or your summary of benefits and coverage.

If you have questions, please call us at 844-214-2381 (TTY: 711). This hotline operates every day from 7 a.m. – 11 p.m.

Here are some additional resources:

  • Find an in-network provider: Check to see if a health care professional or facility is in-network using our Provider Finder.
  • View benefits, estimate costs: For additional information about your specific benefits or to estimate your out-of-network costs, log in at amerihealthnj.com.
  • Check regional costs for services: To see examples of out-of-network costs and service estimates within your region, visit www.fairhealthconsumer.org.

For claims related to air ambulance and providers outside of New Jersey

The following information applies to all AmeriHealth New Jersey benefits plans.

You are protected from surprise billing or balance billing when you receive care from a provider who is located outside of the State of New Jersey or when you use an air ambulance.

Learn more

For all other claims

Your policy covers:

  • Medically necessary treatment by out-of-network health care professionals/facilities in an emergency or urgent situation
  • Inadvertent or accidental out-of-network services
  • Treatment from out-of-network health care professionals/facilities if in-network health care professionals/facilities are unavailable