Usually, authorization and payment for these benefits is the responsibility of a designated carve-out service provider. This document is required by the state to be published, and represents the contract agreement made with the health plan member's employer. This organization provides basic and supplemental health maintenance and treatment for voluntarily enrolled persons within a specific geographic area. This term may refer to individual providers or a Network of physicians and facilities. This type of plan can be a supplement offered with an HMO plan or it may function as a PPO .
Members can see non-contracted providers at a different coverage level or tier.
PPO products are available to individuals and groups. A referral request does not necessarily indicate that a requested service is covered and it does not constitute an Authorization . Insurance companies may include, exclude or Carve Out certain types of specialties from particular plans, such as chiropractic care or acupuncture. HMO members are referred to specialty services by their Primary Care Provider .