Preauthorization Procedure. If You seek coverage for services that require Preauthorization, You or Your Provider must call Us at the number on Your ID card. You or Your Provider must contact Us to request Preauthorization at least two (2) weeks prior to a planned service. If that is not possible, then as soon as reasonably possible during regular business hours prior to the service. After receiving a request for approval, We will review the reasons for Your planned treatment and determine if benefits are available. Criteria will be based on multiple sources including medical policy, clinical guidelines, and therapeutic guidelines.
Preauthorization Procedure. If You seek coverage for services that require Preauthorization, You must call Us at 888-857- 0314. You must contact Us to request Preauthorization at least two (2) weeks prior to a planned service. If that is not possible, then contact Us as soon as reasonably possible during regular business hours prior to the service. After receiving a request for approval, We will review the reasons for Your planned treatment and determine if benefits are available. Criteria will be based on multiple sources including medical policy, clinical guidelines, and therapeutic guidelines.
I. Pre-Determination/Pre-Treatment Estimates. We allow You to request and obtain an estimate of coverage. You or Your Provider may contact Us and request a pre-determination of benefits, also known as a pre-treatment estimate. If We determine that an alternative procedure or treatment is more appropriate than the requested service, You may appeal Our decision through an internal Appeal or external appeal. See the Utilization Review and External Appeal sections of this Contract for Your right to an internal Appeal and external appeal.
Preauthorization Procedure. If You seek coverage for services that require Preauthorization, You must call Us at 888-857- 0314. You must contact Us to request Preauthorization at least two (2) weeks prior to a planned service. If that is not possible, then contact Us as soon as reasonably possible during regular business hours prior to the service. After receiving a request for approval, We will review the reasons for Your planned treatment and determine if benefits are available. Criteria will be based on multiple sources including medical policy, clinical guidelines, and therapeutic guidelines.
