In the medical plan there are provisions for Care Management which require pre-certification and review of certain treatments and procedures.
Pre-certification is also known as "prior-authorization" or "pre-admission review." The process of pre-certification is determining the justification of certain procedures such as inpatient or outpatient surgery, diagnostic tests or physical therapy. You may request your physician obtain pre-certification on your behalf, but doing so is up to the physician.
A nurse at HDP, known as a Nurse Manager, will assist Spectrum participants in processing their pre-certification. As soon as you know that you or your dependent will be admitted to a medical facility for surgery, require a diagnostic test or physical therapy, you should call 1-877-286-3560.
A detailed list of the procedures and services that require pre-certification are listed in the Summary Plan Description (SPD). There is a $250 penalty for not obtaining pre-certification. However, procedures done in the event of an emergency (such as a car accident, heart attack, etc.) do not require pre-certification but HDP must be contacted soon after treatment or admission to the hospital.