AUTHORIZATIONS & REFERRALS
Each IHP PCP is responsible for coordinating the member’s total health care. All covered health services are either delivered by the PCP or are referred/approved by the PCP and/or the IHP. In addition, the PCP is responsible for initiating referrals for specialty care and maintaining continuity of care.
Some services and supplies require prior authorization by Ingham Health Plan in order to be covered. Certain services require medical review so that the Plan can determine if the service is a covered benefit and meets medical necessity criteria.
ONLY OUTPATIENT SERVICES COVERED – NO INPATIENT SERVICES
EMERGENCY DEPT SERVICES NOT COVERED
No authorization needed:
Office visits with your PCP or a Specialist
Routine outpatient diagnostic laboratory
Routine outpatient radiology services
Needs authorization 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
Ingham Health Plan Authorization News: Ingham Health Plan has a new authorization request form available through the IHP portal. Providers are required to login to access the form.