1. How do
I get preauthorized?
It is usually best to have your doctor's office
call us if you need a service or procedure so that we can get
the
necessary medical information and coding, or you can
call our office at 1-800-862-3338 and we will walk you through
it.
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2. What do I need to have
preauthorized?
Preauthorization requirements vary depending on your group
and plan. You can usually check in your benefit handbook
for preauthorization requirements, or call your benefit
company to find out what is required. If you have any
trouble with this, feel free to give our office a call, and
we will help you find the information you need. However,
if
you have a medical emergency, go to the hospital or
urgent care facility in your PPO network. Any necessary authorization
can be taken care of after the fact, and in most circumstances,
the hospital staff will call for authorization. Remember,
it is important that you receive the care you need.
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3. What information is needed
to preauthorize my treatment?
The requirements for preauthorization vary depending
one
what type of treatment you will be receiving. We are
able to preauthorize a number of procedures over the phone
with the proper information regarding the type of treatment,
the diagnosis, the name of the facility, and the name
of
the doctor performing or prescribing the treatment.
In other cases, we may require clinical information such
as chart notes or diagnostic testing results. In any event,
it is best to have your doctor's office call for preauthorization
so that we can get the proper coding and information.
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4. What is medical necessity?
Medical necessity is the determination that a medical procedure
or piece of medical equipment is appropriate for the
patient. Our medically trained review staff acts as an extra
check
to make sure that your treatment is the best choice
for you. As a part of the process, we look at the diagnosis,
and make sure that alternative methods have been explored.
Additionally, medical necessity determinations help
your benefit plan avoid paying frivolous claims, which helps
keep your insurance premium low.
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5. How do you work with my
doctor?
At Innovative Care Management, we interact with your doctor
in a number of ways. Our first contact with your doctor
is typically through our preauthorization process,
where we will obtain information about you and your condition
for our review process. In addition to this, our nurses
will interact with your doctor to suggest alternative
treatments, enhance coordination and communication between
multiple
doctors, medical equipment providers, and hospitals,
and
follow your plan of care. In all instances, our staff
works as a support with your doctor, and is not meant to replace
the care your doctor provides.
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6. How does Innovative Care
Management fit in with my benefit plan?
Innovative Care Management is contracted with your benefit
plan to do medical necessity determinations, case management,
and other aspects of medical management. With several
insurances, various necessary components are contracted out to
other
companies who specialize in that field. This is why you
potentially have different companies and phone numbers to call
for Preferred
Provider Organizations (PPOs), pharmacy benefits, claims
and benefits, and preauthorization. Though it may sometimes
be confusing, this is done so that your benefit plan
can provide the most expertise in each aspect of your insurance.
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7. What is "cost containment",
and how does it benefit me?
Cost containment includes a number of factors aimed at reducing
the amount spent on medical claims. Included in this
are elements such as medical necessity determinations, redirection
to preferred providers, encouraging preventative measures
like proper medical equipment or medication, and discharge
planning, which means helping patients to be discharged
from hospitals early and using services like home health nursing
that is far less expensive, and provides care in the
comfort
of the patient's home. Measures such as these, while
providing all of the necessary care for a patient, also reduce
the
overall cost of expensive healthcare. When healthcare
costs are lowered, insurance premiums remain lower, ultimately
benefiting all members.
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8. Who do I contact to verify
my benefits?
For any benefits questions, you should contact your benefits
company. We contract with a number of different benefit
plans, so your benefits company will be specific to your
plan. If you look on your insurance card, there should
be a phone number for "Benefits and Eligibility",
or something similar. All of your benefits question should
be directed to that company.
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9. When I called to check
on my benefits, I was just told that preauthorization was required
and to call Innovative
Care
Management. How do I just find out if a procedure is covered
under my benefit plan?
Often times, your benefit company may want you to be certain
to preauthorize a procedure, so they immediately will direct
you to us. However, if you just want to find out if something
is covered, it makes a difference how you phrase your question.
When you call your benefits company, ask "Assuming preauthorization,
what is the benefit for this procedure?" If they know
that you are aware that preauthorization is required, they
will then be more willing to give you the benefit information
at that time.
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10. Who do I contact regarding
payment on my claim?
In most circumstances, your benefit company is also your
claims payor. You should look at your insurance card,
and find the phone number for "Benefits and Eligibility".
This will be company to contact for any claims information
as well.
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11. Is my information confidential?
Any information about you that we receive is entirely confidential.
We are in full compliance with the current HIPAA regulations
regarding patient privacy, and we hold your information
with the highest respect. No information will be given
out other than what is necessary for your treatment,
and we employ high security measures to keep your information
safe.
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12. What is a PPO network?
A PPO network is a Preferred Provider Organization. This
means that a number of doctors, hospitals, and other
healthcare providers contract with a PPO network. A PPO network
is
able to negotiate with these providers to have reduced
costs for the services they provide, and thus help
reduce healthcare costs. If your benefit plan has a PPO network,
you should use these providers if at all possible.
The
price of their services will be regulated, making them
more affordable to you. Additionally, several insurances
provide an incentive to use your PPO network by paying
a higher percentage of your charges if you use in-network
providers.
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