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Pre-Certification Requirements
Pre-certification is required for all
non-emergency hospital admissions and surgery and most out-patient
surgeries. MRI’s, CAT Scans and PET Scans do not require
pre-certification. Please call the Fund Office if you have questions
regarding the necessity of pre-certification in a particular
situation.
Plan medical advisors make the final
pre-certification determination. Health Assurance reviews
pre-certification requests for the Plan’s medical benefits; United
Behavioral Health reviews pre-certification for the Plan’s mental
health/substance abuse benefits.
The pre-certification rules of the
Central PA Teamsters Health and Welfare Fund govern and are separate
and different from those of other Health Assurance plans.
If you are using a Network physician,
it is the doctor’s responsibility to contact the Fund Office and
follow its instructions to obtain pre-certification. If you use a
non-Network provider, it is your responsibility to contact the Fund
Office and follow its instructions to obtain pre-certification.
If you have emergency surgery, you or
your provider must notify the Fund Office within 2 business days
after treatment/hospitalization.
Please note: Pre-certification
approval does not automatically mean that a claim will be approved.
The Trustees reserve the right to deny benefits if subsequent
information leads the Plan’s professional advisors to conclude that
the treatment was not medically necessary.
To pre-certify, you must call the Fund
Office at 610-320-5500, toll-free in PA at 1-800-422-8330 or
toll-free nationwide at 1-800-331-0420.
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