Pre-Authorization Requirement

 It is a common practice for an insurance carrier to require pre-authorization for services outside of a primary care visit.  Historically, your employer's health Plan has not required pre-authorizations; however, beginning July 1, 2020, pre-authorizations are required for any service outside your primary care doctor's office.  Here are a few reasons why this new requirement is necessary. 

Saving YOU money

A pre-authorization ensures that the requested medical service is a covered benefit. This is for your financial protection because your physician has never seen your employer's health Plan.  The doctor has no idea what procedures, benefits, tests, medication, etc. are covered or not.  We have had employees who assumed a service would be covered only to find out it was not after receiving a huge bill.  We do not want this to happen to you.  Pre-authorization protects you financially.

Giving YOU control through awareness

 Pre-authorization also protects you medically.  EBL hires a group of nurses and doctors to look over most requests and ensure you are receiving a service that is the most conservative, minimally invasive.  We offer another set of eyes, another opinion based on trusted clinical standards.  You will receive a letter to your home with the outcomes of any medical necessity
study for you or your dependents.

Providing YOU options

Pre-authorization protects you in a second financial way.  EBL can determine what your Plan out-of-pocket cost will be for your procedure at your requested facility.  If there is an opportunity to have the same procedure at a different facility, we will let you know – you will save between $250-$1,000.  It is too hard for you to be aware of all the rules and moving parts of insurance and hospitals.  That is EBL's job.  One phone call to EBL could save you a week's pay. 

What do you need to do now?

If you require a service or test outside of your primary doctor's office, please tell the prescribing physician a pre-authorization is required and have them call EBL at 877-480-7442.