4 ways to avoid surprising medical bills

Receiving a larger-than-expected bill can be stressful. We are here to help! Here are four measures you can take to ensure you are not surprised by your healthcare expenses:

1. Get pre-approval.

Pre-approval helps you understand whether you’re covered by your benefits before having a scheduled procedure. Knowing that your procedure is covered can bring peace of mind and provide clarity on any out-of-pocket costs you might be responsible for.  

2. Avoid unnecessary medical treatment.

LifeWise uses a team of experienced doctors, nurses, and healthcare analysts to determine if a medical procedure is appropriate and supported by clinical best practices.

3. Let in-network doctors secure pre-approval for you.

Healthcare providers who are in the LifeWise network are familiar with the process for getting pre-approval and can contact LifeWise on your behalf. In-network doctors have all the medical information needed to ask that your medical service be reviewed and approved for coverage. Always ask your healthcare provider about requesting pre-approval before you schedule a service or procedure.

If your doctor gives you a service that requires pre-approval without requesting it, you may have to pay for part or all of the service. For complete information about your plan’s medical benefits and pre-approval requirements, read or download your benefit booklet. To avoid extra costs, always ask your healthcare provider to request pre-approval before you have a planned medical service.

4. Know what services require pre-approval.

Services that require pre-approval include:

• Planned admission into hospitals or skilled nursing facilities.
• Some inpatient surgeries.
• Non-emergency ground or air ambulance transport.
• Advanced imaging, such as MRIs, CT scans, and cardiac imaging.
• Transplant and donor services
• Some planned outpatient procedures and surgeries.
• Some injectable medications you get in a healthcare provider’s office.
• Prosthetics and orthotics other than foot orthotics or orthopedic shoes.
• Reconstructive surgery.
• Home medical equipment priced at $500 or more.
• Some drug treatments.

Please note that this is not a complete list and shows only some of the services and drug treatments that require pre-approval or prior authorization. 

Also be aware that if you have a prescription plan benefit, some drugs must be approved for coverage through our Pharmacy pre-approval program. Learn more about drugs requiring approval.

Services that do not require pre-approval include:

• Hospital admission for prenatal, childbirth and newborn care.
• Emergency admission to hospital.
• Office visits to a primary care doctor, a family doctor, or a specialist.

Questions?

Speak to an expert representative by calling customer service at 1-800-817-3056.