PLEASE NOTE. You do not need preauthorization for emergency services. Additionally, you do not need preauthorization from us or from any other person (including a PCP) in order to obtain access to obstetrical or gynecological care from a network physician who specializes in obstetrics or gynecology. Your physician, however, may be required to comply with certain procedures, including obtaining preauthorization for certain services. You may request an expedited preauthorization review in an emergency. We will respond to you with a determination within seventy-two (72) hours following receipt of the request. We review requests for concurrent authorization when you need an extension of an authorized course of treatment beyond the period of time or number of treatments already approved. If we deny your request, we will notify your provider before the end of the treatment period and will let you know within twenty-four (24) hours from receipt of the request if the request is made at least twenty-four (24) hours before the expiration of the period of time or number of treatments. You have the right to appeal our determination or to take legal action as described in this section. We review requests for retrospective authorization when services were provided before authorization was obtained. A notification of the retrospective determination will be provided within thirty (30) calendar days from receipt of the request. You have the right to appeal our determination or to take legal action as described in this section.
Appears in 78 contracts
Samples: Subscriber Agreement, Subscriber Agreement, Subscriber Agreement
