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Here’s our process:
• The doctors find all the facts they can to give a full report
• This information includes evaluations and input from other health care professionals who are
topic experts
• After all the facts are in, the new advancement has a very tough test to go through to see if it is
good for our members
• At the end, we review the advancement with our Benefit Advisory Committee to see if it will be
a new benefit
• Medical professionals review and finalize all benefit policy rulings
Precertification
PPO and EPO Members
All elective admissions below need to be precertified:
• Hospital
• Skilled nursing facility
• Hospice
• Behavioral medicine
You need to tell us about all emergency admissions within 48 hours. The phone number is on the back
of your ID card. If you are admitted to a hospital that isn’t affiliated with us, we will call the doctor
treating you to check your status and your care plan. When it is safe, you may be transferred to an
affiliated hospital. If you say no to the move, your care at the hospital that isn’t affiliated with us will
be covered at a reduced benefit level.