Out-of-network Coverage Rules

It's important to understand your benefits when receiving services from doctors who are outside our provider network. Out-of-network providers aren't required by law to accept Clover members. It's up to the out-of-network provider to decide whether they'll see Clover members or not. We're happy to reach out to out-of-network providers to let them know the benefits of accepting Clover members, but we can't guarantee they'll accept you as a patient.

If you visit out-of-network providers, Clover will cover any service or procedure so long as it's medically necessary and covered by Medicare Parts A or B, or is as an additional benefit offered by our plan. “Medically necessary” means the services, supplies, or drugs are needed for the prevention, diagnosis, or treatment of your medical condition, meeting all accepted standards of medical practice. You may contact us in advance of any service or procedure to confirm it will be covered by our plan by calling 1-844-811-8899 (TTY 711) 8am – 8pm EST, 7 days/week.*

If you move forward with a service or procedure that isn't medically necessary with an out-of-network provider, you'll be held responsible for its full cost.