Benefits corner- When is pre-certification needed with my Priority Health insurance plan?

The following services require a Pre-Authorization- subject to deductible requirements:

1. Imaging Services- MRI, CAT Scans, PET Scans, CT/CTA and Nuclear Cardiac Studies
2. Inpatient Hospital Facility Services EXCEPT in emergencies or hospital stays for a mother and her newborn of up to 48 hours following a vaginal delivery and 96 hours following a cesarean section
3. Inpatient Mental Health & Substance Abuse Services- including rehabilitation and partial hospitalization except in emergencies.

Pre-certification phone number is 800-269-1260.

If you fail to receive pre-certification you may be subject to a $250 fee.

Always feel free to call the customer service number on your Priority card, and access the Health Benefit Plans at

https://www.nmc.edu/departments/human-resources/salaries-benefits/medical-benefits.html#medical