Preauthorization Guidelines
To help you minimize your costs, we recommend you preauthorize medical care when necessary according to these guidelines. If you're enrolled in a contracted HMO, check with your plan representative for information about preathorization guidelines.
General Guidelines for 2007
Services Needing Preauthorization
- Chemical Dependency (Inpatient Services and Outpatient Services)
- Chiropractic Services (Deseret Choice and Deseret Select)
- Dialysis
- Durable Medical Equipment (DME) such as:
Bone Growth Stimulators
Communication devices
CPAP machines
Erect-aids
Helmet therapy
Hospital beds
Insulin Pumps
Lymphopresses
Oxygen concentrators
Pain Pumps
Prostheses
Respirators / Ventilators
Scooters
Seasonal Affective Disorder lights
Spinal Cord Stimulators
ThAIRpy vests for cystic fibrosis
Wheelchairs- Genetic Testing
- Home Health
- Hospital Inpatient Admissions
- Hospice
- Mental Health: Alternative Care
- Mental Health: Inpatient Hospital Services
- Mental Health: Outpatient Therapy
- Obesity Surgery (Inpatient and Outpatient)
- Pain Clinic (Inpatient and Outpatient Services)
- Rehab Inpatient Admissions
- Radiology (new technologies, PET scans, PET –CT, etc.)
- Skilled Nursing Inpatient Admissions
- Speech Therapy
- Transplants
- Transportation
- Wheelchairs (Rental for Post-op)
Services Not Needing Preauthorization
- Outpatient Procedures (Not described above)
- Outpatient Surgeries (Not described above
Questionable Services
Providers and Members are encouraged to call to verify coverage for procedures that may possibly be:
- Cosmetic in nature
- New technology
- Experimental technology
- Exclusion to the plan
Consequences of not Preauthorizing by Medical Plan
Deseret Choice and Deseret Select
Certain Medical Equipment $200 per year Chemical Dependency $200 per day Chiropractic Therapy Must be done through CHP High-cost Radiology Services $200 per service Home Health $200 per day Inpatient Hospitalization $200 per admission Maternity Hospitalization: Extended $200 per admission Mental Health Alternative Care All Charges (No benefit) Mental Health Inpatient Hospitalization $200 per day Mental Health Outpatient Therapy $200 per year Mental Health Testing $200 per day Pain Clinics: Inpatient and Outpatient $200 per day Speech Therapy $200 per year Transportation $200 per year Deseret Premier
Certain Medical Equipment $200 per year Chemical Dependency $200 per day High-cost Radiology Services $200 per service Home Health $200 per day Inpatient Hospitalization $200 per admission Maternity Hospitalization: Extended $200 per admission Mental Health Alternative Care All Charges (No benefit) Mental Health Inpatient Hospitalization $200 per day Mental Health Outpatient Therapy $200 per year Mental Health Testing $200 per day Pain Clinics: Inpatient and Outpatient $200 per day Speech Therapy $200 per year Transportation $200 per year Deseret Value
Certain Medical Equipment $200 per year High-cost Radiology Services $200 per service Home Health $200 per day Inpatient Hospitalization $200 per admission Maternity Hospitalization: Extended $200 per admission Mental Health Alternative Care All Charges (No benefit) Mental Health Inpatient Hospitalization $200 per day Mental Health Outpatient Therapy $200 per year Mental Health Testing $200 per day For more information about your benefits, please see your Benefits Handbook.
If you have any questions, please contact Deseret Mutual.
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