Don't be surprised by a medical bill you weren't expecting
About pre-approval
Did you know that many services and procedures require an OK for coverage from LifeWise before you get them? This is called pre-approval, and it helps you:
- Find out if you're covered by your benefits before you have your scheduled procedure
- Save money and avoid extra costs
- Get an estimate of your out-of-pocket costs before you go
- Avoid inappropriate or unnecessary medical treatment
LifeWise uses a team of experienced doctors, nurses, and healthcare analysts to determine if a medical procedure is appropriate and supported by clinical best practices.
Doctors who are in the LifeWise network can request pre-approval for you
Healthcare providers who are in the LifeWise network are familiar with the process for getting pre-approval. They can contact LifeWise on your behalf. In-network doctors have all of the medical information needed to ask that your medical service be reviewed and approved for coverage. You should always ask your healthcare provider about requesting pre-approval before you schedule a service or procedure.
What happens if your doctor doesn't request pre-approval
If your doctor gives you a service that requires pre-approval without requesting one, you may have to pay part or all of the cost, above your usual cost shares. For complete information about your plan's medical benefits and pre-approval requirements, read or download your benefit booklet.
To avoid extra costs always ask your healthcare provider to request pre-approval before you have a planned medical service.
The list below shows some services and procedures that require pre-approval.
Some services that require pre-approval*
- Planned admission into hospitals or skilled nursing facilities
- Some inpatient surgeries
- Non-emergency ground or air ambulance transport
- Advanced imaging, such as MRIs, CT scans, and cardiac imaging
- Transplant and donor services
- Some planned outpatient procedures and surgeries
- Some injectable medications you get in a healthcare provider's office
- Prosthetics and orthotics other than foot orthotics or orthopedic shoes
- Reconstructive surgery
- Home medical equipment costing $500 or more
- Some drug treatments.
Please note: If you have a prescription plan benefit, some drugs must be approved for coverage through our Pharmacy pre-approval program. Learn more about drugs requiring approval.
*This is not a complete list and shows only some of the services and drug treatments that require pre-approval. Your doctor has the most current list and medical information needed to request a pre-approval on your behalf.
Services that do not require pre-approval
- Hospital admission for childbirth and newborn care
- Emergency admission to hospital
- Office visits to a primary care doctor, family doctor, or specialist
Rights and protections
Find additional important information on your rights and protections as specified by the Affordable Care Act.
Questions?
Call Customer Service at the number on your LifeWise member card.