will apply to all services performed on or after the above revision date which
will become the new effective date.
services referred to in this policy that were performed before the revision
date, contact customer service for the rules that would apply.
maintains a list of procedures currently requiring pre-authorization. This list
is provided to participating health care professionals, who are responsible to
obtain pre-authorization for their patients.
members seek care out of our network, they should check whether the benefit
requires pre-authorization and the benefit payable for any service they
anticipate receiving from an out of network health care provider. This
information can be obtained by calling Customer Service (at the number on the
membership card) or by going online to