Out-of-Area Indemnity Plan
Precertification
To ensure that the medical service ordered is medically necessary, cost effective, and the most appropriate treatment for your condition, prior approval may be required. This is known as precertification for services ordered by any licensed provider.
What requires precertification?
Any licensed provider
- Some services require precertification to be covered, such as:
- Hospital admissions
- Outpatient surgeries
- Inpatient rehabilitation, hospice, or skilled nursing facility services
- MRI, CT, and PET scans
- For a complete list of services that require precertification, see your Certificate of Insurance (COI).
How do I receive precertification?
- You are responsible to obtain precertification. If you fail to obtain precertification, you incur the risk of receiving a penalty up to $500. The penalty does not apply toward your deductible or out-of-pocket maximum. So, it’s important to get precertification.
- You or your doctor should call to ask for precertification before you schedule services by calling 1-888-251-7052(TTY 711). Representatives are available Monday through Friday, 6 a.m. to 6p.m., Pacific time.
- To learn more, review the precertification section in your Certificate of Insurance (COI) for details.
Need precertification?
Call 1-888-251-7052 (TTY 711), Monday through Friday, 6 a.m. to 6 p.m., Pacific time.