Accessing Care While Traveling

If you have a medical emergency or need urgent care, go to the nearest hospital or medical facility for treatment. You don’t need approval from Sutter Health Plan for emergency or urgent care. When traveling within the Sutter Health Plan service area, we encourage you to use an in-network urgent care facility. 

If you’re admitted to an out-of-network hospital, here’s what you need to know:

• Please notify our Customer Service team at 855-315-5800 as soon as possible.
• When it’s safe and appropriate, we’ll work with the out-of-network provider to transfer you to a Sutter Health Plan network hospital. 

There are several ways to get your prescriptions before traveling or while you’re away from home:

• If you use a CVS retail or mail-order pharmacy, you can get up to a 100-day supply (if your plan allows) for the cost of two 30-day supplies. To sign up for CVS Caremark® Mail Service Pharmacy, call 844-740-0635 or visit CVS Caremark^®. Mail order doesn’t apply to specialty drugs.
• If you have valid refills, you can transfer your prescription to an in-network pharmacy for pickup (limitations may apply). New prescriptions can be filled at any network pharmacy. Use the CVS Caremark^® Pharmacy Locator to find one near you.
• To pick up your prescription early (up to a 90-day supply), you can request a vacation override by calling CVS Caremark^® at 844-740-0635. Each prescription is eligible for one override every six months, with standard cost-sharing.

If you received emergency or urgent care from an out-of-network provider and need to file a claim for out-of-pocket costs, you must file a claim for reimbursement. Here’s how to file a claim:

• For medical services, complete a Member Claim Form on the Member Portal or download a PDF version. Include any bills and receipts from the provider.
• If you paid out-of-pocket for a prescription drug at a retail pharmacy, submit a claim at CVS Caremark^®.

We’ll send you a written decision within 30 days of receiving the claim from you or the out-of-network provider unless we notify you within those initial 30 days that we need additional information. If your claim is denied in whole or in part, we’ll send you a written decision explaining the denial and providing instructions for filing a grievance.