What are the pre-certification requirements for inpatient hospital confinements, maternity or residential treatment care?
Inpatient hospital care rendered in the United States requires pre-certification. Pre-certification must be obtained by calling our underwriter, Mutual of Omaha at 1 800 593-2354. If pre-certification is not obtained there is a $500 penalty. Anytime Medicare Part A is primary, we waive pre-certification, and our deductible and coinsurance. Pre-certification is not required for services rendered outside of the United States. However, the Plan will review all services to establish medical necessity. We may request medical records in order to determine medical necessity. We may request medical records in order to determine medical necessity. Note: Non-PPO Residential Treatment Centers are not covered.
