Benefit preauthorization to confirm medical necessity is required for certain services as part of our commitment to help ensure all EMI Health members get the appropriate care, at the appropriate time, in the appropriate setting.
EMI Health continually monitors procedures requiring preauthorization and makes adjustments as necessary.
For the new plan year (plans renewing on or after 09/01/2020), major diagnostic tests will require preauthorization.
As a reminder, if the member uses a participating provider, the provider (not the member) is responsible for preauthorization. If the member uses a non-participating provider for treatments or procedures requiring preauthorization, the member is responsible for obtaining preauthorization, and benefits may be denied or reduced if preauthorization is not obtained. Refer to the plan document for more information regarding preauthorization.
We appreciate the opportunity of providing your healthcare coverage.
If you have any questions about this notice, please do not hesitate to call our customer service team at 800-662-5851 or send an email to firstname.lastname@example.org.