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Provider Network

Alignment Health Plan selects its providers with care and has developed a great provider network for our members to choose from. Browse through our site to see which providers are available in your area.

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Out-of-Network Policy for HMO Members

  • Alignment Health Plan HMO members must receive care from a network provider.
    A

    In most cases, care you receive from an out-of-network provider (a provider who is not part of our plan's network) will not be covered. You are responsible for paying the full cost of services that aren't covered by our plan, either because they are not plan-covered services or they were obtained out-of-network and were not authorized.

    Here are three exceptions:

    1. The plan covers emergency care or urgently needed care that you get from an out-of-network provider.
    2. If you need medical care that Medicare requires our plan to cover and the providers in our network cannot provide this care, you can get this care from an out-of-network provider. Prior authorization is required before you get care from an out-of-network provider. In this situation, you will pay the same as you would pay if you got the care from a network provider. For information about getting approval to see an out-of-network doctor, please refer to your Evidence of Coverage.
    3. Kidney dialysis services that you get at a Medicare-certified dialysis facility when you are temporarily outside the plan's service area.
  • When can you use a pharmacy that is not in the plan's network?
    A

    Your prescription may be covered in certain situations

    We have network pharmacies outside of our service area where you can get your prescriptions filled as a member of our plan. Generally, we cover drugs filled at an out-of-network pharmacy only when you are not able to use a network pharmacy. Here are the circumstances when we would cover prescriptions filled at an out-of-network pharmacy:

    1. If you are unable to get a covered drug in a timely manner within our service area, because there are no network pharmacies within a reasonable driving distance that provide 24-hour service.
    2. If you are trying to fill a covered prescription drug that is not regularly stocked at a network retail or mail order pharmacy (these drugs include orphan drugs or other specialty pharmaceuticals).

    In these situations, please check first with Member Services to see if there is a network pharmacy nearby.

  • How do you ask for reimbursement from the plan?
    A

    If you must use an out-of-network pharmacy, you will generally have to pay the full cost (rather than your normal share of the cost) at the time you fill your prescription. You can ask us to reimburse you for our share of the cost. Please refer to your Evidence of Coverage for a description of how to ask the plan to pay you back.


Search our Provider Network

  • Find a Dentist
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    For plans with coverage through the FLEX Allowance, members may visit a dental provider of their choice that accepts VISA. There is no network restriction or impact on covered standalone benefits. For additional information regarding the FLEX Allowance benefit, members can call our ACCESS On-Demand Concierge at 1-833-242-2223 (TTY: 711), available 24 hours a day, 7 days a week.

    Arizona: DentaQuest

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    California: Liberty Dental

    Participating dentists vary based upon plan election.

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    Florida: Liberty Dental

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    Nevada: Careington Dental Discount

    Coverage and provider network(s) vary by plan and is administered through Careington Dental and/or FLEX Allowance.

    For plans with coverage through the FLEX Allowance, members may visit a dental provider of their choice that accepts VISA. There is no network restriction or impact on covered standalone benefits. For additional information regarding the FLEX Allowance benefit, members can call our ACCESS On-Demand Concierge at 1-833-242-2223 (TTY: 711), available 24 hours a day, 7 days a week.

    Members also have the option to obtain savings on dental services at participating providers via the dental discount plan. To view the dental network, click the link below to be routed to the Careington website.

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    North Carolina: Careington Dental Discount

    Coverage varies by plan and is offered through the dental discount plan and/or Flex Allowance.

    Members can visit a dental provider of their choice that accepts VISA. There is no network restriction or impact on covered standalone benefits. For additional information regarding the FLEX Allowance benefit, members can call our ACCESS On-Demand Concierge at 1-833-242-2223 (TTY: 711), available 24 hours a day, 7 days a week.

    Members also have the option to obtain savings on dental services at participating providers via the dental discount plan. To view the dental network, click the link below to be routed to the Careington website.

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    Texas: Liberty Dental

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  • Find an Eye Doctor
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    For plans with coverage through the FLEX Allowance, members may visit a vision provider of their choice that accepts VISA. There is no network restriction or impact on covered standalone benefits. For additional information regarding the FLEX Allowance benefit, members can call our ACCESS On-Demand Concierge at 1-833-242-2223 (TTY: 711), available 24 hours a day, 7 days a week.

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  • Find a Hearing Provider
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    Alignment provides hearing care through a network of more than 4,000 provider locations in the United States. Search for a network provider location near you.

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  • Find a Care Center
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    Alignment Health Centers are owned and operated by Alignment Health and services are exclusive to Alignment Health Plan members.

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  • Find a Fitness Class
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    Alignment cares about your physical and mental well-being. With our Peerfit Move partnership, enjoy access to gym memberships and fitness classes at various facilities across the country – or access online at-home workouts – all at no extra cost to you.

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