News
AMBETTER HEALTH ALLOWS REIMBURSEMENT FOR OUT-OF-NETWORK BEHAVIORAL HEALTH SERVICES DURING STATE OF EMERGENCY
Date: 10/16/23
Thank you for being an Ambetter from Western Sky Community Care member.
On September 19, 2023, the New Mexico Superintendent of Insurance issued an Emergency Order in response to Executive Order 2023-132. This declared a state of emergency due to drug abuse. The Emergency Order is effective immediately and will remain in effect until the Executive Order is rescinded by the governor.
As a member of Ambetter from Western Sky Community Care, your overall physical and mental health are very important to us. We want to remind you that you have access to mental health and substance use disorder services as part of your benefit coverage with us.
During the time of the public health emergency, you may access mental health and substance use disorder services at the in-network benefit level when services are performed by an out-of-network provider. Please note, provider balance billing may apply for out-out-network provider claims. Further, prior authorization is not required for any out-of-network care and/or services that would not otherwise be required for in-network care and/or services.
Ambetter from Western Sky Community Care will cover the following out-of-network services at the cost-sharing levels listed below.
Service | Coverage |
Mental/behavioral health outpatient services | Covered at in-network primary care visit cost-sharing levels |
Mental/behavioral health inpatient services, including facility fees | Covered at in-network inpatient physician and surgical services cost-sharing levels |
Mental/behavioral health emergency care, including facility fees | Covered at zero-dollar cost-sharing levels |
Mental/behavioral health urgent care | Covered at in-network specialist visit cost-sharing levels |
To submit your out-of-network claims and/or reimbursement requests directly to us, please complete this Member Reimbursement Medical Claim form (PDF) and email it as an attachment to ContactUs_MemberServices@CENTENE.COM.
If you would rather mail the form, you can print the form and a copy of this notice, and mail them together to the following address:
Ambetter from Western Sky Community Care
Claims Department - Member Reimbursement
P.O. BOX 5010
Farmington, MO 63650-5010
For additional assistance, please call member services at 1-833-945-2029 (TTY 711).