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.