Some services require precertification. If you use an in-network or participating provider, the doctor or facility is responsible for obtaining prior authorization for certain services.

However, if you use an out-of-network provider, it is your responsibility as the patient/plan member to obtain precertification prior to receiving services from an out-of-network provider (physician, facility or another medical provider). If you do not obtain precertification, you will be responsible for the full cost of out-of-network care.

The services and supplies listed on this flyer require precertification.

Note that items marked with an asterisk (*) are NEVER covered when received from an out-of-network provider.