Page 51 - EPO_Member_Kit

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P R E C E R T I F I C A T I O N
As a part of the precertification process, Alliance
reviews all requests for admission and certain
procedures and treatments before they are provided to
ensure medical appropriateness. For assistance
regarding which services require precertification,
please call a Client Services Specialist. Failure to
receive precertification may result in a $250 penalty.
Admissions
All elective admissions (including hospital, skilled
nursing facility, hospice and behavioral medicine) must
be precertified and Alliance must be notified of all
emergency admissions within 48 hours. Instructions to
precertify hospital stays can be found on your ID card.
Emergency Admissions
If you have a medical emergency and are admitted to a
hospital we must be notified within 48 hours. The
telephone number is on the back of your ID card.
If you are admitted to a non-affiliated hospital we will
contact the doctor treating you to evaluate your medical
condition and the doctor’s treatment plan. When it is
safe to do so, you may be transferred to an affiliated
hospital. The cost of a transfer is a covered service if the
transfer is authorized and arranged by Alliance Health
and Life Insurance Company. Refusal to transfer means
your continued care at the non-affiliated facility will be
covered at a reduced benefit level.