Request a network exception review
Document access barriers and ask whether the plan offers an exception.
The member link opens the tool directory. Search for “Request a network exception review” after signing in with active access.
Reviewed process guidance
See what the workflow asks.
This page describes the actual guided questionnaire. It collects no answers, opens no private record and runs no task. You can explore the questions before choosing whether to use your own member workspace.
What you may work through.
These are the catalog’s question labels and help text, not a public intake form. Omit names and identifiers when they are not needed. An evidence-reference question records where you keep material; it is not an upload.
- 01
Required Medical Specialty
Short text · required by this questionnaire - 02
Out-of-Network Provider
Short textOptional private reference. Omit names and identifiers when they are not needed.
- 03
In-Network Provider Limitations
Listed choice · required by this questionnaireListed choices
- No in-network providers with required specialty
- In-network providers have long wait times (over 30 days)
- Geographic barriers - nearest in-network provider too far
- In-network providers lack required expertise/credentials
- Continuity of care - established relationship with OON provider
- Medical complexity requires specific provider expertise
- 04
Type of Treatment/Service
Listed choice · required by this questionnaireListed choices
- Surgery requiring specialized expertise
- Rare disease treatment
- Complex diagnostic evaluation
- Specialized therapy/rehabilitation
- Second opinion consultation
- Ongoing specialized care management
- Emergency/urgent specialist care
- 05
Geographic Access Issues
Longer answer - 06
Medical Complexity/Urgency
Longer answer · required by this questionnaire - 07
Prior Provider Relationship
Listed choice · required by this questionnaireListed choices
- Long-term established patient relationship
- Provider familiar with complex medical history
- Previous successful treatment by this provider
- Referred by current treating physician
- No prior relationship
What you work through.
These are the current catalog’s preparation steps, shown only while the supporting receipts remain within their review windows.
- 01
Keep records of in-network searches and responses
- 02
Ask what evidence the plan requires for an exception or continuity request
- 03
Obtain written approval and its payment terms before assuming out-of-network care is covered
Evidence to have ready
- Network search record
- Plan exception instructions
- Clinician support
Sources and review dates.
These are dated research receipts, not live retrieval or a finding about your bill. Check whether each source applies to your situation.
ACA and Consolidated Appropriations Act implementation FAQs, Part 49 ↗
Provider-directory reliance protections for applicable group and individual coverage; verify plan, timing and evidence.
- Reviewed
- 2026-09-27
- Review due
- 2026-12-27
Official source material reviewed (page, PDF or indexed excerpts); applicability still requires case facts.
Protection from unexpected out-of-network bills ↗
Qualifying private coverage; emergency, certain in-network facility services, air ambulance; confirm exceptions.
- Reviewed
- 2026-09-27
- Review due
- 2026-12-27
Official source material reviewed (page, PDF or indexed excerpts); applicability still requires case facts.
Limits to understand.
- Your answers stay in this local preparation. They are not automatically added to AI requests, submitted, or used to decide eligibility.
- Verify the current plan, provider policy, and actual notice deadlines; a request or phone call does not automatically pause them.
Task breadth is not proof of clinical or legal accuracy, eligibility or savings. GoldRock does not contact the provider, submit an appeal, grant assistance or confirm an outside outcome through this page.
Find the task.
Prepare the next move.
Your own answers belong in the registered workspace, with the applicable access and saving choices.