Make Sure You're Covered

  • Avoid surprise medical bills

    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. Always ask your healthcare provider about requesting pre-approval before you schedule a service or procedure

    What 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.

    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

    *The above is not a complete list and shows only some of the services and drug treatments that require pre-approval. Your doctor has the current list and medical information needed to request pre-approval on your behalf.

    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.

    Services that do not require pre-approval

    • Hospital admission for prenatal, childbirth and newborn care
    • Emergency admission to hospital
    • Office visits to a primary care doctor, family doctor, or specialist

    Questions?

    Call the customer service number on your LifeWise member card.