Are referrals or prior authorizations needed to receive care?
To receive care from a personal care physician (PCP) or a specialist, referrals are not needed, but members must receive care from the network physicians listed in the provider directory. Pre-certification is required for all elective inpatient hospital care, the admitting physician (or PCP) is required to call AHL and get pre-certification for the elective admission at 313-664-8950 or 1-800-926-3436. In addition, on the day of the elective admission, the hospital is required to call AHL at 1-888-477-7587. For emergency care, prior approval is not required. If the member needs to get admitted for inpatient care, we require the hospital to call AHL within 48 hours of the non-life threatening emergency admission at 1-888-477-7587 and follow the prompt to be connected to the Prior Authorization department. For life-threatening emergencies requiring admission prior approval is not required. For behavioral and substance use care, members need to call Coordinated Behavioral Health Management
