Pre-certification

​​Pre-certification means that a particular healthcare service must be reviewed and approved in advance to be covered by the Medical Plan. 

The back of your medical ID card lists the tests, procedures, and admissions requiring advance approval. These include the following services:

  • hospital admissions for nonemergency medical or surgical treatment, including maternity
  • bariatric or other weight-loss surgery
  • scheduled outpatient imaging, excluding X-rays and ultrasounds
  • scheduled nuclear stress tests
  • all facility-based treatment for behavioral health or substance use disorders*
  • biofeedback and electroshock therapies
  • prescriptions for medical injectable drugs

Allow up to 10 days for pre-certification of a non-emergency service. 

All emergency hospitalizations, whether for medical, surgical, behavioral health, or substance use disorder treatment, must be pre-certified within 48 hours of admission. Benefits are payable only if pre-certification requirements are met.

If you do not pre-certify

The pre-certification process helps to manage costs for members and the plan by ensuring care is medically necessary and appropriate. If you fail to pre-certify services when required, benefits may be denied.

*To find a network facility and to maximize your coverage, call the Member Services number on your medical ID card to determine medical necessity and to pre-certify the proper level of care.