Each proposed hospital admission, inpatient or outpatient surgery, and other procedures as noted in the Certificate Wording must be precertified for medical necessity. It is important to note that precertification is only a determination of medical necessity, not an assurance of coverage, verification of benefits or a guarantee of payment. All medical expenses must meet usual, reasonable, customary, and eligible payment guidelines. Please refer to the Certificate Wording for full details of the precertification requirements.
Please note that this online service will only initiate the precertification process, and it should not be used to precertify emergency admissions, procedures, or evacuations.Please call +1.317.655.4500 for emergency medical evacuation requests. Do not use this precertification form for evacuation requests.
You will be notified upon receipt of this precertification. It remains the Insured person's responsibility to verify benefits. All conditions and provisions of the Insured person's certificate of insurance apply.
Please call (317) 655-4500 for Emergency Medical Evacuation requests. Do not use this form for Evacuation requests. You will be notified upon receipt of this precertification. Precertification is not a guarantee of payment nor is it a denial. It remains the insured person's responsibility to verify benefits. All conditions and provisions of the insured person's certificate of insurance apply.