Outpatient Services

Verify Your Benefits

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

Outpatient Procedures:

Call us to obtain authorization for the following procedures that are performed as an outpatient in an acute medical facility, an acute medical rehabilitation facility, a free-standing facility, a subacute rehabilitation facility, an urgent care facility or in a health care practitioner’s office.

Call at least 7 business days prior to receiving any non-emergency outpatient services that are listed below.

Call within 24 hours, or as soon as reasonably possible, after receiving the following outpatient services for emergency treatment.
  • Any surgical procedures.
  • Invasive cardiology services for diagnostic or therapeutic cardiac procedures, except cardiac catheterization and percutaneous transluminal coronary angioplasty (PTCA).
  • Invasive radiology services for diagnostic or interventional purposes.
  • Dialysis.
  • Radiation therapy

Authorization is not required for laboratory services, endoscopies and noninvasive diagnostic imaging service such as xrays, magnetic resonance imaging (MRI), computerized axial tomography (CAT scan), ultrasound or nuclear medicine scans.

Transplants:

Call at least 7 business days prior to any transplant evaluation, testing, preparative treatment or donor search.
Disclaimers
  • 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.