MHP offers our clients a Point of Service (POS) option. When the POS option is selected, the member has the option of receiving most types of care from non-network providers. Referred Access POS members need not obtain referrals for services sought outside of the network.
When electing to use this option, the member will be responsible for the payment of a deductible, co-insurance, and any amounts over Usual and Customary (U&C) for the service regardless of whether his/her 'base' plan is Referred or Open Access. The same financial exposure results when Referred Access POS members seek care from an in-network specialist without having obtained a prior referral from their primary care physician.
The member is responsible for assuring prior authorization is obtained, or the benefit will be decreased by the amount of the non-compliance penalty. The non-compliance penalties range from 50-100% depending on the type of service obtained. Non-compliance penalties do not apply to deductibles or yearly or lifetime maximums and are subtracted before any application of deductible or coinsurance.
While members may receive most care from non-network providers, the following services are considered covered benefits when received from in-network providers only (Missouri groups):
Preventive care services including well woman exams;
Mental health and substance abuse services;
Transplant services;
Mammography;
Dialysis services;
Orthotic equipment;
Chiropractic care;
Infertility service; and
Sterilization.