The PHCS (Private Healthcare Systems) Network
Enrollees have access to all providers in the PHCS Network. All elective care must be rendered by a PHCS Network provider to be considered in-network. Exceptions to this rule which will be considered in-network include authorizations from Medical Management to receive services from non-PHCS Network providers due to medical necessity as well as services received in an Emergency Room setting for emergency situations.
Enrollees may also receive professional (not institutional) services from a non-PHCS network provider at an in-network benefit level should there be no equivalent PHCS Network provider within thirty (30) miles. In such cases, the allowed reimbursement for claims received from the non-PHCS Network provider will be limited to the PHCS Network allowable for those services, and the non-PHCS Network provider may in turn bill the enrollee for the balance. The same reimbursement limit and potential for balance billing will apply to claims received from non-PHCS Network providers with authorizations from Medical Management due to medical necessity as well as to claims for services received in an Emergency Room setting for emergency situations.
To find a PHCS Network provider, select the link above.
