When I seek preauthorization for a service, what actually gets approved – the service, the provider or the providers charges?
Preauthorization determines if the treatment is medically necessary. It is only for the purpose of reviewing whether the service is necessary for the care or treatment of the illness. Preauthorization does not guarantee that all charges will be covered, nor does it consider whether you are seeking treatment at a PPO or non-PPO facility. In other words, preauthorization does not waive the PPO provisions of the Plan, and does not provide coverage for services excluded or limited by the Plan.
Related Questions
- Can I seek out my own service opportunities or do I have to participate in Spalding events or the ones specifically listed on the Approved Outreach opportunities form?
- When does my new customer actually switch from another incumbent provider to Ambit for their electric service?
- How do applicants seek approved service provider status?
