Referrals and prior authorizations

You want to get the care you need when you need it. We make it easy.

HMO members

Referrals

Need to see a specialist? No problem. With HAP, specialty office visits don’t require referrals from your primary care physician. But in some cases, the specialist you see may require a referral from your PCP. Many specialists are booked out months in advance, and may only accept patients whose PCP believes they need specialty care.

Prior authorization

Sometimes specialists may suggest procedures we don’t feel are the best course of action for a patient. That’s why we want members to check with us so we can help manage their care. This is called prior authorization. If your service requires prior authorization, your doctor will take care of it on your behalf.

Example:

When Mary visits the ear, nose and throat doctor for the first time, she pays her specialist office copay. After her consultation, the ENT recommends a sinus surgery for Mary. Before she has the surgery, the ENT’s office must get prior authorization from HAP to make sure the service is covered and that it’s medically necessary.

For hospital stays

For inpatient hospital stays, your doctor will get prior authorization from HAP. Emergency room visits don’t require prior authorization. Simply, notify HAP within 48 hours of the emergency admission.

PPO members

You don’t need to worry about referrals, but your PCP would be a good resource to find a specialist who is right for you. With a PPO plan, you have the flexibility to seek care from doctors in and out of the network. But remember, you might pay more if you choose a doctor outside of our network.

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Copyright © 2017 HAP
2017 Health Alliance Plan of Michigan
Y0076_ALL_2018029 Website MP
CMS Approved: 6/26/2017
Last Update: 6/21/2017

HAP Senior Plus HMO, HMO-POS, and PPO are health plans with a Medicare contract. Enrollment in these plans depends on contract renewal. HAP Senior Plus PPO is a product of Alliance Health and Life Insurance Company, a wholly owned subsidiary of HAP. Alliance Medicare Supplement is a product of Alliance Health and Life Insurance Company, a wholly owned subsidiary of HAP.

This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums, and/or copayments/coinsurance may change on January 1 of each year. You must continue to pay your Medicare Part B premium. The formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.

  • HAP Medicare Sales:

    (877) 547-5186 (TTY:711)

  • (800) 868-3153 TTY: 711

    HAP Senior Plus®

    (800) 801-1770 TTY: 711

  • HAP Senior Plus®(PPO)

    (888) 658-2536 TTY: 711

  • Alliance Medicare Supplement:

    (800) 873-7526 TTY: 711