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Out of Network Coverage (Part C)

In most cases, you must receive your care from an IlliniCare Health doctor. There are some times when network providers may not be offered or nearby. Those times are:

  • In an emergency.
  • When urgent care is needed that you cannot get from a network provider.
  • When care is needed that cannot be offered by a network provider.
  • Continuity of care.
  • Kidney dialysis services when you are outside the plan’s service area with approval from your primary care provider or IlliniCare Health. Without an authorization you will have to pay for the service.

In some cases your doctor may send you to an out-of-network doctor. Your doctor will need to get prior approval from the health plan. Some of those times may be because:

  • Services are not available in network as soon as you need them.
  • Your doctor decides that a non-network provider would be better for you.

See the Benefits Chart in your Summary of Benefits.

Call IlliniCare Health Member Services at 1-877-941-0482. Hours are 8 a.m. to 8 p.m., Monday through Friday. After hours, on weekends and on holidays, you may be asked to leave a message. Your call will be returned within the next business day. TTY users call 711.