Preauthorization

• Preauthorization Contact
• Preauthorization Requirements
• Penalties for the Failure to Preauthorize Required Benefits

To obtain medical preauthorization, please use the following contact information:

Preauthorization is required for the following benefits:

• Inpatient Care provided under the Plan with the exception of required maternity admissions.
• Maternity and/or Newborn Inpatient care beyond 48 hours for a normal delivery or 96 hours for a cesarean section.
• Intensive Therapy, Partial Facility Care and Inpatient Mental Health Benefits.
• Intensive Therapy, Partial Facility Care and Inpatient Substance Abuse Benefits.
• The purchase, rental, repair or replacement of Durable Medical Equipment.
• All Outpatient intravenous therapy and related services.
• Outpatient Surgery at Hospitals and Ambulatory Surgery Facilities (no Preauthorization necessary for endoscopic procedures.

Please note: The WELS Benefit Plans Office will provide to members the necessary information to obtain Preauthorization. In case of emergency Inpatient care, the member must obtain authorization within 48 hours or the next business day.

Medical Care Benefits

If a member fails to obtain Preauthorization for Medical Care Benefits, the Plan imposes the following penalties:

Each Occurrence

Each time that the member fails to obtain Preauthorization for an Inpatient admission, the Plan will not pay $200 of the charges the member has incurred.

Intensive Therapy, Partial Facility Care and Inpatient Mental Health and Substance Abuse Benefits

If a member fails to obtain Preauthorization, the Plan will not reimburse charges for the types of care listed above.