MEDICAL PROVIDER NETWORK

Choose Your Location:
Inside the United States
Outside the United States

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INSIDE THE UNITED STATES

ChoiceCare | ALL STATES EXCEPT New York and New Jersey

Click Here to search for providers in the ChoiceCare Network.
Make sure that the Network selected is "ChoiceCare Network PPO"

In the US for all States except New York and New Jersey, when you call a doctor's office for an appointment or present your ID card to a provider, it is important for you to say: "My healthcare coverage utilizes the ChoiceCare PPO Network. Are you a ChoiceCare Provider?"

 

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Beechstreet | ONLY IN STATES New York and New Jersey

Click Here to search for providers in the Beech Street Network.
Make sure that the Plan Type selected is "Primary"

In New York and New Jersey, when you call a doctor's office for an appointment or present your ID card to a provider, it is important for you to say: "My healthcare coverage utilizes the Beech Street PPO Network. Are you a Beech Street Provider?"

 

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ASPE health care benefit plan contains a Medical Provider Network inside the US. A Medical Provider Network is a network, or group, of doctors and hospitals that have entered into an agreement with Seven Corners to accept discounted fees for medical services. The Medical Provider Network is a Perferred Provider Network (PPO). Claims for services provided by a Preferred Provider are mailed directly to Seven Corners at the address on the back of your identification card.
If you receive your medical services from one of the doctors and hospitals in the Medical Provider Network your benefits will be paid at the negotiated provider contracted rate if they are a covered benefit. Also, if you use a provider in the Medical Provider Network the provider can not bill you for any covered benefits except the $15.00 co-pay for office visits, ER, urgent care or hospitalizations.

USUAL, CUSTOMARY AND REASONABLE CHARGES (UCR)
If you do not receive care from a provider in the Medical Provider Network, benefits will be paid at standard Usual, Customary and Reasonable Charges (UCR) for the area in which care was delivered if they are a covered benefit. If the provider bills more than UCR, you will be responsible for any charges over and above the UCR, as non-preferred providers are not under negotiated contracted rates.

35 MILE EXEMPTION
If your home address is over 35 miles from the nearest medical network provider, you are exempt from the provider network guideline. You are free to see any provider of your choice. You will need to call Seven Corners Customer Service to coordinate this exemption.

OUT-OF-NETWORK CHARGES
If you pay for your medical services out-of-pocket or are billed at the time of service you will need to submit a claim for payment or reimbursement.

ADDITIONAL INFORMATION
If you want to discuss your provider choice with Customer Services, you can call customer service toll free in the US at 1.800.461.0430.
Do not wait to find a provider for Emergency Care. Go straight to the nearest ER. Emergency care is defined by Seven Corners as a need for hospitalization, trauma (i.e., broken bones, accidents), acute and spontaneous non-controllable pain, blurry vision, intense headache, chest pain, shortness of breath, unmanageable high fever, open wounds, or any life-threatening situation.
If you have a life-threatening emergency, please call your local emergency service or go to the nearest hospital. If you are unsure where the nearest hospital is located, the Seven Corners staff can assist.

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