Common use of Pre-Admission Certification Clause in Contracts

Pre-Admission Certification. If a member or a dependent is informed that a non-emergency inpatient admission or inpatient psychiatric treatment is necessary, the admission must be pre-certified by the City's medical utilization review administrator. If no pre-certification was made, a ten percent (10%) co- insurance will be applied, in addition to the deductible and co- insurance provisions. This ten percent (10%) co-insurance does not apply to the out-of-pocket maximum. If the hospitalization is determined not to be medically necessary, the member will be responsible for the cost of all medically unnecessary care. If using a PPO network provider, the provider will be responsible for pre-certification. The member is responsible for pre- certification if a non-participating provider is used.

Pre-Admission Certification. If a member or a dependent is informed that a non-emergency inpatient admission or inpatient psychiatric treatment is necessary, the admission must be pre-certified by the City's medical utilization review administrator. If no pre-certification was made, a ten percent (10%) co- insurance will be applied, in addition to the deductible and co- co-insurance provisions. This ten percent (10%) co-insurance does not apply to the out-of-pocket maximum. If the hospitalization is determined not to be medically necessary, the member will be responsible for the cost of all medically unnecessary care. If using a PPO network provider, the provider will be responsible for pre-certification. The member is responsible for pre- pre-certification if a non-participating provider is used.

Pre-Admission Certification. If a member or a dependent is informed that a non-emergency inpatient admission or inpatient psychiatric treatment is necessary, the admission must be pre-certified by the City's medical utilization review administrator. If no pre-certification was made, a ten percent (10%) co- co-insurance will be applied, in addition to the deductible and co- co-insurance provisions. This ten percent (10%) co-insurance does not apply to the out-of-pocket maximum. If the hospitalization is determined not to be medically necessary, the member will be responsible for the cost of all medically unnecessary care. If using a PPO network provider, the provider will be responsible for pre-pre- certification. The member is responsible for pre- pre-certification if a non-non- participating provider is used.