may need advance approval from your plan. This is called a"prior authorization" or "preauthorization." Please 
contact your PCP or refer to the Evidence of Coverage (EOC) for services that require aprior authorization from the 
plan .
c
10 Summary of Benefits H5216107000SB23 H5216107000 
Covered Medical and Hospital Benefits  (cont.) 
IN-NETWORK OUT-OF-NETWORK 
You may be billed by the  
out-of-network provider for any  
amount greater than the  
payment made by Humana to  
the provider.