Finding a Provider
For assistance finding a provider, access the network sites below or contact our Care Guides at 866-815-6001. Refer to your ID card for the applicable provider network you have access to through your plan.
If you don’t see the network listed on your ID card, please contact our Care Guides at 866-815-6001 for assistance.
America's Pharmacy Resource
Member Resource Documents
The Member Resource Document includes details for your reference on:
Transition of Care / Continuity of Care
Transition of Care allows new members and/or members whose plan has experienced a recent provider network change to continue to receive services for specified medical and behavioral conditions, with health care professionals that are not participating in the plan’s designated provider network, until the safe transfer of care to a participating provider and/or facility can be arranged.
Continuity of Care allows members the option to apply to receive services at in-network coverage levels for specified medical and behavioral conditions, from their current health care provider if the provider is or is soon to be out-of-network. This arrangement will be allowed until the safe transfer of care to a participating provider and/or facility can be arranged.
Open Negotiation Notice
Reference the below Detego Health Open Negotiation Notice for details on the process your provider must follow for disputing the allowable rate used on your claim.
Machine Readable Files
In compliance with the Transparency in Coverage Rule, health insurers and group plans, including self-insured plan sponsors, are required to provide pricing data through machine-readable files* (MRFs), effective July 1, 2022.
As of January 1, 2023, the Transparency in Coverage Rule mandates member access to a healthcare price comparison tool.
We have partnered with TALON to bring you access to MyMedicalShopper™; which provides you the ability to shop for healthcare services based on price, quality, and location. Just like we shop for everything else! Use your member subscriber ID to access the pricing tool using the link below.
If you need assistance with the shopping tool or with obtaining pricing please contact our Customer Service Team at 877-585-8480.
*These files will be updated monthly