In some instances, if MedStar Family Choice is unable to provide a medically necessary and covered service to a member within the MedStar Family Choice network, MedStar Family Choice may allow the service to be provided out of network. For this to happen, the provider must contact MedStar Family Choice to request prior authorization. In these cases, MedStar Family Choice has two (2) business days to process a request once all necessary information has been received.
In all cases, MedStar Family Choice must make a decision within seven (7) days of receiving a request for authorization. The decision period may be shorter depending on the urgency of the request. MedStar Family Choice will review all requests on an individual basis. In cases where out of network services have been approved, you are not responsible for the cost of these services.
Information current as of: