Policies & Procedures

SAGA Out-of-Network Services

In certain circumstances, on a case-by-case basis, a request may be made to CHNCT for a non-participating provider referral. These requests must be submitted prior to the provision of care or services. The circumstances that will be considered are as follow:

There is no participating primary care provider within a 20- mile radius, or
There is no participating specialist reasonably accessible to the member, or
The services and/or care requested is highly specialized and it has been determined that the care cannot be provided in-plan. Additionally, clinical supporting documentation has been provided to the CHNCT Medical Director for review, or
It is an urgent situation and the provider office calls in for a one-day authorization, or
A change to a participating provider would be injurious to the health status of a member, i.e. end-of-life care or mid cancer treatment protocol. However, in certain circumstances, a transition plan to a participating provider may be developed with a finite number of transition visits to the non-par approved.

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Policies & Procedures