CalCPA ProtectPlus

Out-of-Network describes services or visits rendered by non-participating hospitals, non-participating physicians and other non-participating providers, and with respect to services or visits covered on an in-network basis only if provided by COE, services or visits provided by any Provider other than a COE.

(COE) are health care providers which have a Centers of Expertise Agreement in effect with the claims administrator at the time services are rendered. COE agree to accept the COE negotiated rate as payment in full for covered services. A participating provider in the plan network is not necessarily a COE. A provider’s participation in the plan network or other agreement with the claims administrator is not a substitute for a Centers of Expertise Agreement.