Introduction
Two of the largest categories
of medical expenses for this plan are hospitalization and surgery. To help
control these expenses, the plan contracts with a medical review agency to
administer the plan’s medical review program.
The medical review program is
designed to let you and your physician know whether certain admissions and
surgeries are medically necessary and covered by the plan
before
you undergo treatment and incur expenses. The medical review program includes
the following:
- Preadmission
certification for inpatient hospital admissions.
- Second
surgical opinions for certain surgical procedures.
- Medical
case management for certain medical
conditions.
You
and your dependents must use the medical review program even if you have other
insurance (except Medicare).
Failure to
use the medical review program may result in a reduction in
benefits.
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