Pre-Notification of Medical ExpensesAs a component of the Member Stewardship Advisory Program, Pre - Notification is a process by which Liberty HealthShare can advise members how to avoid unnecessary services, hospitalizations, and shorten inpatient confinements, while improving quality of care and reducing expenses shared by the members. Providing sufficient advance notice, whenever possible, is a responsibility of a sharing member in order to allow Liberty HealthShare the opportunity to provide a variety of suggestions designed to avoid unreasonable billing practices by some physicians and many facilities. Our processes do not dictate what medical treatment a member chooses, but rather are designed to help members assess impending interactions with a complex and confusing medical system. As with anything in life it pays to do a little research. We have a great membership administrative unit dedicated to answering your questions and helping you get the best care in an affordable way. As a member if you ever have any questions about what types of expenses are eligible for sharing or whether your specific expense is or will be eligible, we recommend you call in and ask the question.
In certain circumstances we require that a member pre-notify the admin staff of our upcoming expenses. This will not only verify eligibility for sharing, it will also help the group negotiate for you and get the best pricing and get the best care.
It is the responsibility of the Sharing Member to make sure that the Pre-Notification staff is contacted and to not count on the physician or facility to do so . Liberty HealthShare’s relationship is with the member, not the medical provider. To be eligible for cost sharing, Pre-Notification is required for the following:
- Inpatient Hospital Confinements (including Hospital, Skilled Nursing, Inpatient Rehabilitation Facility and Hospice) The term "Inpatient" includes any facility admission , observation or other confinement that lasts more than 23 hours.
- Organ/Tissue Transplant Services
- Emergency Admissions as soon as it becomes evidently needed
- Extended emergency department observation periods and observation care.
- For all Home Health Care Services
- All Outpatient Surgery (including surgical centers, clinics, hospitals)
- Obstetric and prenatal needs — member must notify Liberty HealthShare SM directly upon learning of pregnancy — as early as possible.
- Maternity. Upon admission or anticipated admis sion for Labor and Delivery, C Section or inpatient management during pregnancy.
- Non-emergent Magnetic Resonance Imaging (MRI) scans
- Positron Emission Tomography Scanning (PET) .
- Cardiac catheterization
- Cardiac rehabilitation
- Diagnostic Colonoscopy
- Before initiation of chemotherapy or radiation therapy.
- Upon diagnosis of cancer while therapeutic decisions are being considered.
- Any expected regular or repeated utilization of the following services
- Occupational therapy
- Physical therapy
- Speech Therapy
- Outpatient respiratory therapy
- Laboratory testing that is used for disease and wellness screening, is expensive, unusual, not proven to be beneficial in well - designed studies, or that in aggregate will cost more than $400.
- For any Complementary or Alternative Medical management, subsequent to an initial evaluation, regardless of whether a CAM licensed provider or an MD or DO.
In general, if you have any questions as a member please call and ask. If you have something that you need to take care of that will be expensive, please contact the Member Stewardship Pre-notification team.
Please review the guidelines section C-19 on page 17 for more information.