Group Employee Handbook
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      How to Plan a Treatment at the Hospital (Pre-Approval)

      Request for our "Pre-Approval" to benefit from a swift direct-billing service.

      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 medical-th@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:
        • All medical records from the first visit until present
        • All lab investigation results including X-ray, ultrasound, CT/MR, etc. 
        • Breakdown of estimated costs
        • Doctor's order for the operation or preoperative set note/treatment plan

      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 number and email address of our Claims Team are listed on your Member’s Card. If an emergency hospitalization occurs, we must be contacted 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

      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.