Pre-Certification of Hospitalization
The Covered Person is responsible to fulfill the Pre-Certification requirement of this Plan:
- Pre-Certification of Non-Emergency Hospitalizations: The patient, Doctor or Hospital must telephone the Utilization Review Organization at least 5 days prior to the planned admission.
- Notification of Emergency Admissions: The patient, patient's representative, Doctor or Hospital must telephone the Utilization Review Organization within 5 days of admissions.
If the Covered Person does not secure Pre-Certification for non emergency admissions or provide notification of emergency admissions, his/her Eligible Expenses will be subject to a reduction of $750. Pre-Certification is not a guarantee that benefits will be paid.
In the case of life and/or organ threatening situations, the consultation must take place as soon as reasonably possible. To pre-certify a hospitalization or diagnosis or treatment method, call First Health Network (FHN) at 1-800-572-5508.
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