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Q: Are there certain services that I must get prior authorization for before the service can be performed?

A. Yes. Prior authorization of services is an acknowledgement to the provider that a specific medical service is payable by the plan. Prior to obtaining the below services, the patient should verify that their provider has received prior authorization from MCTWF. If no prior authorization has been received, the claim will be rejected and the patient will be responsible for full payment of the charges:

•  Blepharoplasty & Ptosis Repair; Upper Lid
•  Breast Reduction
•  Breast Reconstruction
•  Durable Medical Equipment – Purchase
•  Growth Hormone Stimulation
•  Home Health Care
•  Hospice
•  PET Scans

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