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Working with your doctors

Supporting your doctors in caring for you

To help keep your health care experiences running smoothly, we have a diverse group of doctors to choose from.

Our network

We work with thousands of doctors, hospitals and other types of providers throughout the state. We may refer to this group as any of the following:

  • Plan providers
  • Providers we work with
  • Our network

Plan providers are contracted with us. This means:

  • They meet our strict quality standards
  • They agree to get paid certain rates to treat and care for you
  • They aren’t allowed to bill you when you get services that are included in your plan

You must always get medical services from providers we work with unless:

  • It’s an emergency
  • You need specialty care and a plan provider is unavailable (you will need to get preapproval before you get services)

Otherwise, you may have to pay the bill.

To search for plan providers close to you, use our Find a Doctor tool. 

Out-of-network care

There may be times when you need care but a plan provider isn’t available close by. This may happen when you need to see a specialist (like an allergy doctor, skin doctor or another specialist). If we can’t help you get medically needed services from a plan provider, we’ll arrange for you to get care from a doctor outside our plan.

To get out-of-network care, you’ll need preapproval first. To get preapproval, either:

  • Talk to your primary care provider (PCP)
  • Call Member Services at 1-800-600-4441 (TTY 711)

When you get out-of-network care, whether in Washington or out of state, you may have to pay for the services and then submit a claim to us.

Make sure your provider understands you’re submitting the bill to your insurance company so they’ll give you the correct billing form. To get a claim form, call Member Services. Then mail your claim to:

Claims department
P.O. Box 61010
Virginia Beach, VA 23466-1010

Second opinion

Sometimes you may want to get a second opinion. We can help you get a second opinion from a doctor either inside or outside our network. To get help, call Member Services at 1-800-600-4441 (TTY 711).

Care management

If you have an ongoing or chronic medical condition that needs care over long periods of time, you may be eligible for care management. Our care managers are nurses who will:

  • Get to know you and your health history
  • Work with you and your doctors to set up a plan of care
  • Help you set up appointments, get support at home and more
  • Get referrals and preapprovals
  • Send records to your other doctors (when they need them)

If you have a serious medical condition and would like extra support, call our Care Management team at 1-855-323-4688, ext. 33118.

Out-of-area care

If you’re traveling outside Washington State and you need medical care, you can:

  • Call your PCP for advice (even if the office is closed, he or she or another provider should be on call and able to help)
  • Call Amerigroup On Call at 1-866-864-2544 (TTY 711)

In an emergency, always call 911 or go to the nearest hospital right away. We cover emergency care anywhere in the United States.

Specialty care

If you need to see a specialist, talk to your PCP. He or she will give you a referral or help you get preapproval.

Specialists are doctors with training in special areas of medicine. Some examples of specialists are:

  • Allergists (allergy doctors)
  • Dermatologists (skin doctors)
  • Cardiologists (heart doctors)
  • Podiatrists (foot doctors)

You don’t need a referral from your PCP to see a behavioral health specialist in your plan. There are some treatments and services that need preapproval before you can get them. To learn more, talk to your doctor.