I have read about “precertification” of services. What services do I need to have precertified?
The Health Plan’s contract requires precertification for inpatient hospital stays. Home nursing care and services of either a physical, speech or occupational therapist, and durable medical equipment require prior approval (High Option). See the Plan’s Federal Brochure (RI 71-004) to determine if a service you are about to receive needs precertification or preauthorization. Unless a hospital stay takes place outside of the United States or Puerto Rico, or unless you have other insurance, including Medicare Part A as your primary health insurer, all inpatient hospital stays must be precertified. If a hospital stay is not precertified, a $500 penalty will be assessed when the claim is paid. Planned admission into the hospital must be precertified at least 48 hours prior to the admission to avoid the precertification penalty. If you have an emergency admission or an unscheduled maternity admission, you must certify the stay within 48 hours of the admission, even if you have already been d
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