Dateline: NH, February 2018

New HMO Network Requirement

Laurie Churchill, Field Representative

Effective January 1, 2018 Harvard Pilgrim will require registered, out-of-area dependent members on their HMO plans to use their out-of-area dependent network when they receive care outside of their plan’s enrollment area.

Members will have until March 1 to start seeing a participating out-of-area dependent provider if they are not already seeing one. After February 28, the only services Harvard Pilgrim will cover from non-participating providers are urgent care and medical emergencies. Out-of-area dependent members can call Harvard Pilgrim’s member services department if they have questions or concerns about the providers in their area.

Harvard Pilgrim wants to make sure that out-of-area dependent members take advantage of their unique relationship with UnitedHealthcare, which gives them access to a strong provider network of more than 775,000 providers nationwide.

Harvard Pilgrim’s out-of-area dependent provider directory became available online as of January 1.

To find participating out-of-area dependent providers, members should:

  • Go to www.harvardpilgrim.org.
  • Click on “Find a Provider”.
  • Choose “Out-of-Area Dependent Directory” under “Standard Plans”.

Registered, out-of-area dependent members who are in active treatment with a non-participating provider for certain illnesses, injuries or other medical conditions can work with staff from Harvard Pilgrim’s Clinical Transition Program to make a coordinated transition to a participating provider. To learn more, call 888-888-4742 and say “Clinical Transitions” after the prompt.

Harvard Pilgrim has notified affected out-of-area dependent members. As of March 1, it is important to use one of the UnitedHealthcare nationwide network of doctors, hospitals and other health care providers. UnitedHealthcare is America’s biggest health insurance provider.

If you have any questions, contact me at lchurchill@nhada.com, or contact anyone in the NHADA Insurance Division with a call to 800-852-3372.