Your policy provides a program that is available to you 24 hours a day, 7 days a week and it is only a phone call away. By calling our toll free number at 1-877-575-4207 you can receive information that will enable you to maximize your insurance benefits.
The Care Coordination Program provides:
- Medical and Benefit Support
- Enhanced PPO Locator Service
- Non-Network Negotiation and Exception Services
- Case Management-Special Care for Special Cases
- "Building Blocks" Pregnancy Program
- Cancer Case Management Program
- Medical/Transplant Case Management
- Disease Management
- Precertification Initiation
The Care Coordination Program has dedicated Customer Service Representatives who understand your needs and who can access your file promptly to provide you with the answers you need. Should you need information for a specific medical condition, a medical professional will provide useful information.
A PPO is a Preferred Provider Organization that has contracted with doctors, hospitals, or other healthcare providers who have agreed to provide services at negotiated rates. CGI contracts with the PPOs to create a network plan. By calling us at 1-877-575-4207, our Customer Service Representatives can help you locate a network provider for covered services. You can also click here for our online provider locator.
Your out-of-pocket expenses are lower because most charges are based on lower negotiated fees. By calling the Care Coordination Program at 1-877-575-4207 our Customer Service Representatives will work closely with you to locate and direct you to a PPO provider. Click here for provider locator.
Call our toll-free number 1-877-575-4207, any time, any day. You can also use the online locator by clicking here. Participating providers change regularly. You should check with your provider prior to receiving services or treatment to ensure they are a participating provider.
Precertification is necessary for inpatient admissions and following emergency admissions to determine if medical services or admissions are medically necessary and appropriate. Precertification will assure that you maximize your medical benefits and have the opportunity to take advantage of our case management services, if appropriate. Obtaining precertification does not guarantee payment of benefits, since all claims are subject to the terms of the certificate booklet/policy.
Just have your doctor call 1-877-575-4207 to initiate the precertification process. This precertification requirement varies by state.
No, outpatient services do not need to be precertified.