Getting Care
Do I need a referral to see a specialist?
No. Clover Health’s PPO plans have an open network, and you don't need a referral to see a specialist.
Are my doctors covered? What happens if my doctor is out of network?
Check your plan's Summary of Benefits document or Evidence of Coverage document for a description of your share of cost for services, both in- and out-of-network. You can receive care from any provider who is willing to bill Clover Health, but depending on your plan's benefits you may pay a different amount of money for the same services.
Providers that are out-of-network are not required by law to accept Clover Health members, and it's up to the provider whether they want to see Clover Health members and whether or not they want to bill Clover Health. Call us anytime to see if a provider is willing to have a billing relationship with Clover Health, or to find a doctor who accepts our members. We're happy to reach out to any provider on your behalf to see if they'll accept Clover Health.
Why should I choose an in-network provider?
Our in-network providers know our benefits well, and they understand how to help you get the most from your coverage. Even if your share of the cost is the same in- and out-of-network, we encourage you to develop a relationship with an in-network provider. Your plan's Evidence of Coverage document and Summary of Benefits describe your share of cost in- and out-of-network.
How much will my service/procedure will cost?
The Evidence of Coverage document associated with your plan is your best tool for estimating your financial responsibility. This document describes what your plan covers and what your financial responsibility could be for any covered benefit. The online version is identical to the printed one, and it describes all our benefits, associated costs, and how to access care.
Can you answer a question about a bill from a provider?
If you are uncertain about your share of cost or a bill you received, give us a call at 1-888-778-1478 (TTY 711) 8 am–8 pm local time, 7 days a week.* We will review the bill to ensure that you were billed the correct amount and assist in correcting it if necessary.