In-Patient Hospitalization

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In-Patient Hospitalization

Please note: the information on this page is provided as a basic reference and should not be considered all-inclusive. Please refer to your Customer Guide, Summary of Plan Document, or Certificate of Coverage for complete details.

See the front of your Customer ID card for the Customer Service phone number and a summary of when to call. Services are available toll-free to answer questions to determine if and how services are covered under your benefit plan.

Planned Hospitalizations

To obtain the highest level of benefits for an in-patient hospitalization, it's important to follow the requirements stipulated by your policy. Before your next in-patient hospitalization, make sure to verify the following information:

  • What hospitals are part of your plan network? Visit Find a Doctor to assist you.
  • Is there a limit on how long I can stay in the hospital?
  • Who decides when I am to be discharged?
  • Will needed follow-up care, such as nursing home or home health care, be covered by my plan?
  • If I have a serious medical problem, will my plan provide someone to oversee care and make sure my needs are met?

Prior Authorization

Unless it is a medical emergency, you need to contact the phone number listed on your ID card to obtain advance approval before you to go to the hospital. Otherwise, the cost of your hospital care may not be covered.

Before you are admitted to the hospital ask yourself:
  • Is there an alternate level of medical care that provides the same quality of care as the hospital? Home care and subacute facilities may offer high quality, cost-effective alternatives for some medical conditions.
  • Is pre-admission testing available? Necessary lab and many X-ray tests are available on an out-patient basis prior to your admission to the hospital on an in-patient basis.
  • Avoid elective admissions on the weekend. Elective surgery and testing is typically available on weekdays only.
  • Ask about discharge planning early. Your physician and other hospital staff can answer questions about how long you need to be in the hospital and the care and/or equipment you'll need on discharge.
  • Understand how your benefit plan handles getting a second doctor's opinion to determine whether surgery or another treatment is needed. Are second opinions encouraged or required? Who pays?

When to Call

Scheduled inpatient hospital stay - not including OB or in-patient hospital stays for mental health/chemical dependency treatments unless required under your plan. However, if not required, we strongly recommend getting pre-certification for mental health/chemical dependency treatment. At least 3 business days in advance

Is your doctor in your network?