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The Keystone Plan
How
to Get Basic Health Care | How
to See a Specialist | How
to Deal With a Need For Emergency Medical Care
How
to Get Continuing Care After Emergency Medical Care | What
Medical Services Need Preapproval
Keystone
Participating Providers | How
to Change Your Primary Care Physician or Referred Specialist
Prescription
Drug Discount Program | Interpreter
Services | Other
Important Information About Keystone
What Medical Services Need Preapproval
Certain covered services need to be authorized by your
primary care physician and preapproved by Keystone prior
to you receiving them. The primary care physician or referred
specialist will obtain this approval from Keystone prior
to providing services to you. Services in this category
include, but are not limited to: hospitalization; certain
outpatient services; skilled nursing facility services;
and home health care. Services requiring preapproval are
noted in your “Summary of Benefits,” pages 42-44. You
have the right to appeal any decisions through the grievance
process. Instructions for the appeal will be described
in the denial notifications.
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