Some services and supplies require approval by Ingham Health Plan in order to be covered. Certain services require a special medical review so that the plan can decide if the service is medically necessary and a covered benefit.
No authorization needed:
Office visits with your PCP or a Specialist
Routine outpatient diagnostic laboratory
Routine outpatient radiology services
Authorization Required before service:
Ophthalmologic exams and testing (Medically necessary - no vision services)
Physical Therapy (12 visits per year)
Needs a special review to determine coverage:
- Genetic testing
- Reconstruction Surgery
- Skin Procedures
- Vein Treatments & Surgery
- Any service that could be considered cosmetic or not medically necessary
- Unclassified procedure codes
Your provider must submit an Authorization. Contact your provider prior to receiving these types of services.