Patients & Visitors
Managed Care Patients
If you have an insurance plan such as an HMO, PPO or POS, you should read your policy book carefully. Some of the things your plan may or may not include are:
Pre-certification (Preauthorization)Prior to non-emergency admission or referral to a specialist, plans may require notification from you and/or your physician. The types of information they request include the name of the facility, physician, specialty, name of disease or illness, expected length of treatment or hospitalization. Failure to obtain preauthorization may result in non-payment by the insurance carrier. It may be possible in some cases to obtain a retroactive authorization.
Denial of CoverageShould your carrier deny a service or stay in the institution, you or your physician have specific rights to appeal. Only your physician has the right to make the decision to discharge you. If you have questions, the following New Jersey State offices may help you with your concerns:
Department of Health and Senior Services (800) 367-6543
Department of Banking and Insurance (800) 838-0935