Please note: the information on this page is provided as a basic reference and should not be considered all-inclusive. Please refer to your Member Guide or benefit plan for complete details.
See the back of your Member ID card for a quick summary of when to call, along with the necessary phone numbers to call. Member Services is available at 1-888-915-4001 to answer questions to determine if and how services are covered under your benefit plan.
To obtain the highest level of benefits for an out-patient hospitalization, it's important to follow the requirements stipulated by your policy. Before your next out-patient hospitalization, make sure to verify the following information.
Check into the following:
Preauthorization is a review process which takes place during out-patient service situations, they're enacted according to the requirements of your policy or can be enacted at your request.
A team of medical professionals review preauthorizations. They determine if your proposed service is covered in your benefit plan, and if it's medically necessary (as per your plan's definition) for your care.
Before deciding a course of action on a particular out-patient medical service, please check your benefit plan and determine if any preauthorizations are required prior to proceeding.
Below are some examples of medical services for which preauthorizations are strongly encouraged:
To request a preauthorization, fax your request to 1-608-226-4777 or call 1-800-333-5003.
Out-patient surgery or services (only if required by your plan)
At least 3 business days in advance