Each proposed hospital admission, inpatient or outpatient surgery, and other procedures as noted in the Certificate Wording must be pre-certified for medical necessity. It is important to note that pre-certification is only a determination of medical necessity, not an assurance of coverage, verification of benefits, or a guarantee of payment. All medical expenses must meet usual, reasonable, customary, and eligible payment guidelines. Please refer to the Certificate Wording for full details of the pre-certification requirements.
A pre-authorization is done upon the completion of a pre-certification and is used by IMG to give medical providers the applicable benefit information for the member, so that they may directly bill IMG for services rendered.
How do members request a pre-authorization?
A pre-authorization is issued on medical services outside of the United States that request pre-certification. Requests for pre-authorization can be initiated by the member or the provider. These may be emailed directly to GOP@imglobal.com. As the pre-authorization is on a procedure or test that requires pre-certification, the pre-authorization will not be issued until the benefits and the pre-certification are determined.
What information do members need for a pre-authorization?
To start a pre-authorization, the following information will be needed: the names and contact information of the providers, the service and date it is to be performed, the diagnosis, and a cost estimate for the physician and facility fees.
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