Do I still need to precertify for hospital admission if I use a PPO hospital?
Yes. The Federal government requires that all members of a fee-for-service plan must precertify their hospital admissions. To precertify, you or your doctor must call your Regional Service Center at 1-800-410-7778 at least two business days prior to hospital admission or within two days of an emergency admission, even if discharge has occurred. Maternity admissions for routine deliveries do not require precertification unless a medical condition requires a stay more than 48 hours for a regular delivery or 96 hours after a Cesarean section. Newborn confinements that extend beyond the mother’s discharge must also be precertified. Failure to certify your hospital admission will result in a $500 reduction in your benefits for that admission.
