Non-emergency health procedures must be precertified.
In the event of a non-emergency hospital confinement, the insured or the admitting physician must contact the insurance administrator a minimum of fifteen (15) days prior to admission to certify the admission based upon proven medical necessity. The administrator must receive complete
medical records of the insured from the treating physician.
In the event of an emergency admission, the insured or the hospital in which the Insured is confined must contact the insurance administrator within forty-eight (48) hours of admission and/or confinement, regardless of whether or not said individual has been discharged. See this article on how to contact Morgan White.
In either event of hospitalization, the administrator must receive complete medical information to evaluate the case, including the admission report from the hospital, diagnosis, treatment required and expected date of discharge. If surgery was required, the administrator will need the surgeon’s report and the anesthesiologist report.
When notified in advance, and if the claim is considered admissible, the administrator will send a guarantee of payment (GOP) to the hospital in accordance with the certificate conditions the Primary Insured has chosen. The administrator will settle the claim directly with the hospital. Failure to comply with the above guidelines will result in a penalty and/or reduced benefits.
If you need assistance with your claim, reach out to your broker or use the chat icon below.