PPO provider referral to non-PPO provider may result in member sanctions

If a PPO provider refers a member to a provider who does not participate in the network, members may be responsible to pay additional out-of-pocket costs.

The PPO policy, as referenced in the provider manual, states:

Under our referral policy, we ask TRUST providers to refer PPO members to other TRUST providers when referrals are necessary. Because the TRUST network encompasses a large scope of participating providers, referrals outside the network are acceptable only in rare case — that is, when covered services are medically necessary and are not reasonably available with the TRUST network. Under those conditions, out-of-network deductibles and copayments may still apply.

For more information about referral policies or any referral forms that may be required, see the chapter titled “PPO Policies” in the provider manual and click on Referrals.

If you have any questions, contact your provider consultant.