Pre-Authorization: Getting Approval for Treatment
Pre-authorization helps us ensure your chosen treatment aligns with your policy coverage. If your coverage is eligible, we will inform the hospitals of your eligibility by placing a letter of guarantee. This guarantees direct billing, ensuring your peace of mind before you visit the hospital and significantly reducing waiting time at discharge.
Here's how to apply, depending on the provider:
- In-Network Providers: Your hospital can assist you in submitting a pre-authorization request. You can also check with them regarding the status of your request.
- Out-of-Network Providers: If your provider is outside our network, you can submit a request directly by emailing cs@lumahealth.com. Be sure to include all necessary details in your email.
Important Note: Pre-authorization does not guarantee final approval. LUMA will review your request based on your specific policy terms and conditions.
In case of any doubt about your coverage or pre-authorization process; please contact our Customer Service teams at cs@lumahealth.com
What procedures require a Pre-Authorization?
We recommend letting us know about any planned hospital visits, including:
- Hospitalization (especially for an elective surgery)
- Daycare treatment / outpatient surgery
- Doctor visits (e.g., check-ups, vaccinations)
- Medical transportation
Whenever possible, please contact our Customer Service teams at cs@lumahealth.com two weeks before entering a hospital or undergoing outpatient surgery. If an emergency hospitalization occurs, the hospital must contact LUMA within 24 hours of admission.
For the following elective surgeries, the Covered Person is recommended to obtain a Second Medical 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