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ACPro: How to Plan a Treatment at the Hospital (Pre-Approval)

When to Request our Pre-Approval

Before receiving inpatient treatment, you are requested to obtain pre-approval.

  • In case of visiting a hospital within our network:
    • Your doctor may request pre-approval for a high-cost treatment. You can inform the hospital to send the required documents to Luma at claims@lumahealth.com
    • We will review the documents and confirm the coverage within 14 working days. However, the process may take longer for cases that require further confirmation.
  • In case of visiting a hospital outside our network, please prepare the following documents:
    • IPD/OPD records from first visit until present
    • All lab investigation results including X-ray, ultrasound, CT/MR, etc. 
    • Breakdown of estimated cost
    • Doctor's order for the operation or preoperative set note/treatment plan
    • Completed Pre-Approval Form

Hospitalization, outpatient surgery, and medical transportation

  • Prior approval is recommended in all cases of hospitalization, outpatient surgery, and 
    medical transportation (except for local emergency transportation). Plan payments 
    may be reduced to the lower usual and customary tariff of our medical network.
  • When a doctor recommends hospitalization, you should discuss with him/her whether 
    an alternative such as surgery performed on an outpatient basis, skilled nursing care, 
    or home health care might be advisable. 
  • You are requested to contact our prior approval team counselor one or two weeks before 
    entering a hospital or undergoing outpatient surgery. The telephone and fax numbers 
    of our prior approvals team are listed on your Member’s Card. If an emergency 
    hospitalization occurs, we must be contacted within 24 hours of admission.
  • When possible, you should take hospital pre-admission X-ray and laboratory tests 
    outside the hospital before you are admitted. You should review the hospital bill and 
    inform us if you find errors.

For the following elective surgeries, the Covered Person is recommended to obtain a second surgical opinion:

  • Coronary bypass
  • Reconstruction of hip
  • Surgery of the big toe to correct deformity (including bunion) 
  • Removal of uterus (hysterectomy)
  • Surgery of the back (laminectomy/fusion)
  • Removal of knee cartilage
  • Dilation and curettage
  • Cataract removal
  • Surgical removal of hemorrhoids
  • Removal of prostate (complete or partial)
  • Removal of gall bladder
  • Bone surgery of the foot
  • Removal of all or part of the kneecap
  • Surgical reconstruction of the nose (including submucous resection)
  • Surgery of tendon sheath (wrist only)
  • Removal of tonsils and/or adenoids
  • Surgery of the breast
  • Hernia repair
  • Varicose vein surgery

Dental treatment and orthodontic work 

You are requested to submit the dental treatment plan to us and to obtain prior 
approval of benefits before major work is started. Prior approval of benefits means a 
review by us of a dentist’s planned treatment and expected charges. If there is a major 
change in the treatment plan, a revised plan should be sent to us.