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.