PRECERTIFICATION BY MED-CARE MANAGEMENT DOES NOT GUARANTEE PAYMENT OF BENEFITS. The Plan’s normal coverage rules and limitations still apply.
When your doctor recommends surgery or a hospital admission for you or a covered family member, the following rules apply if you want to get the max-imum benefits possible:
The decision by Med-Care to pre-certify your hospitalization or surgery determines the Plan’s payment obligations; of course, the final choice about your medical care is always up to you and your doctor.
If you or a covered family member are admitted to a hospital due to an emergency, Med-Care must be contacted no later than the next business day following the admission if you want to get the maximum benefits possible. You, your doctor, or a family member may make the call, but it is ultimately your responsibility to see that the call is made.
Before receiving any care for the treatments or conditions listed below, you or your doctor must call Med-Care for precertification that the treatment is medically necessary and meets the Plan’s coverage requirements.
Call 1 (800) 367-1934 FOR REVIEW
Call for review and precertification of ALL:
If the Treatment is Not Precertified
If you fail to follow the rules of the Medical Care Review Program, your benefits will be reduced or denied as follows: