Health Plan News
Emergency Room visits
A $50 deductible will be applied to ALL ER
visits. The deductible will be waived if the service is a result of an injury
accident*, admission, or 23-hour observation.
* Injury accident - means non-occupational bodily injury that is caused by an event that is external. Violent, sudden and not foreseen, exact as to time and place and independent of all other causes.
Physical/Speech/Occupational Therapy
Just a reminder that ALL therapy requires a
pre-certification PRIOR to starting sessions. In order for coverage, all
visits must be certified and if they are not, the Health Plan will deny
payment. There have been several cases not certified and we are unable to
authorize a retro-review that is more than 2 weeks after the initial
visit. PLEASE call the Plan Officer if you have any questions.
All in-patient, as well as some out-patient procedures/surgeries require pre-cert as well. This includes ALL biopsies whether done in a hospital or physician's office. PLEASE, prior to any procedure or surgery, contact the Plan Office to see if a certification is required. You can locate the number to pre-certify on the back of your Health Plan card.