Do I need approval from my health plan before receiving services?
Most insurance plans require an authorization for specific services. The terms of the contract you have with your plan determine whether services are covered or not or if an authorization is required. Insurance benefits are constantly changing. We recommend you contact your employer or your insurance company regularly to stay informed.
If a hospital in our system does not participate with your insurance plan, you may be responsible for higher co-pay and/or deductible than if you received service from a provider that your insurance plan participates with.
Health Maintenance Organizations (HMO) require that you contact your primary care physician or health plan before receiving services. If you do not obtain prior approval, you will be responsible for payment. In true emergency situations (life threatening), as determined by your health plan, approval can be obtained up to 24 hours after service has been provided.
If a required approval was not obtained prior to receiving elective, non-emergent services, you may be asked to sign a waiver. Signing a waiver is acknowledging that authorization for the services is required, but has not been received. Also, it is accepting responsibility to pay for services not paid by your insurance plan for this reason.
