In-Patient Admissions

Verify Your Benefits

We recommend you verify your benefits before obtaining services whenever possible. Please contact us at 800-553-7654.

Inpatient Confinements:

Call us to obtain authorization for an admission to, or transfer between, an acute behavioral health inpatient facility, an acute medical facility, an acute medical rehabilitation facility, a behavioral health rehabilitation and residential facility, a subacute rehabilitation facility, a hospice facility, a skilled nursing facility or any other inpatient confinement that will exceed 24 hours as follows:

Non-Emergency Confinements:

Call at least 7 business days prior to an inpatient admission for a non-emergency confinement that will exceed 24 hours in length.

Emergency Confinements:

Call within 48 hours, or as soon as reasonably possible, after admission for an emergency confinement that will exceed 24 hours in length. The covered person must provide or make available to the medical review manager the full details of the emergency confinement.

Maternity Confinements:

If the inpatient confinement exceeds 48 hours following a normal, vaginal delivery or 96 hours following a cesarean section delivery, the covered person must call prior to the end of the confinement, or as soon as reasonably possible.

Any other inpatient confinements that occur during a pregnancy must be authorized in accordance with the non-emergency confinements and emergency confinements provisions above.

Continued Stay Review

We may request additional clinical information during an inpatient confinement. Failure of the health care practitioner or facility to provide the requested information will result in non-authorization of continued inpatient confinement. No benefits will be considered until the additional information is received by us. No benefits will be paid for the days of inpatient confinement beyond the originally scheduled discharge date if the continued stay would not have been authorized by the medical review manager based on review of the additional information provided.
  • This is not a guarantee of benefits and the policy must be in force at the time of service. Claims will be reviewed for payment upon receipt and all policy terms will apply.
  • If coverage is subject to the waiting period for pre-existing conditions, services may not be covered. Services will be reviewed to determine if they are for a pre-existing condition.