Senior woman going over health care options

Precertifications

What You Need to Know

To take full advantage of your benefits as a member of Senior Care Plus, you must understand which services require precertification. You are responsible for ensuring that you notify Senior Care Plus before certain services and procedures are performed.

All inpatient hospitalizations
All inpatient rehabilitation
All same-day surgery – except diagnostic and screening colonoscopies which do not require authorization
Skilled Nursing Facility admissions
Durable Medical Equipment over $100
Home Health Services

Transplant Services – excluding outpatient diagnostic testing, laboratory or x-ray
Pain-management services, including trigger-point injections
Office visits to specialists – excluding chiropractic and in-office procedures
Some medications also require authorization. Please refer to the formulary for information on specific medications.

Call our Customer Service Department at 775-982-3112 to request a precertification prior to obtaining the service or procedure.

Senior Care Plus performs Utilization Review only to precertify the medical necessity of the above services for the care and treatment of an illness or injury. Senior Care Plus will also review for alternative methods of medical care or treatment. Precertification by Senior Care Plus does not guarantee that all charges are covered under the policy. Charges submitted for payment are subject to all terms of the policy.

If a member fails to secure a precertification prior to receiving the services listed above, benefits are reduced to a 50 percent coinsurance level. This reduction is in addition to any other deductible and copayment under the policy.

It is important to remind your physician of these precertification requirements. Both you and your physician can contact our Customer Service Department to complete the precertification process.

Senior Care Plus
A Medicare Advantage organization from Hometown Health

Material ID: H2960_2023_SCPWebsite1_M (CMS Accepted)

Last updated: July 21 2020