Utilization Management Program and Precertification
Please see your benefit booklet to determine what services require precertification under your plan.
Precertification is required for many services, including the following outpatient hospital benefits, physician benefits and other covered services. Below is the list of specific services in these categories that require precertification. This list will be updated no more than twice a calendar year. You should check this list prior to obtaining any outpatient hospital services, physician services and other covered services.
Select Outpatient/Office Services
The following services are included in this category and will require precertification:
- Blepharoplasty, Brow Lift or Ptosis Repair
- Breast Reconstruction
(precertification no longer required beginning 4/1/2023) - Gastric Restrictive Procedures (if covered by the group plan)
- Implantable Bone Conduction Hearing Aids
- Knee Arthroplasty
- Lumbar Spinal Fusion
- Motorized/Power Wheelchair
(precertification no longer required beginning 4/1/2023) - Reduction Mammoplasty
(precertification no longer required beginning 4/1/2023) - Rhinoplasty
- Surgery for Obstructive Sleep Apnea
- Surgery for Varicose Veins
- Wireless Capsule Endoscopy
(precertification no longer required beginning 4/1/2023)
