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When your Physician recommends elective or non-emergency hospitalization or Inpatient surgery, you must call the Blue Cross Blue Shield Medical Service Advisory (MSA) for prior approval of the admission at least one business day before you go into the Hospital. Contact the Blue Cross Blue Shield MSA at 1-800-255-5192.
If you have an emergency admission, you, your Physician, the Hospital or a family member must call the Blue Cross Blue Shield MSA within two business days of the date of your admission. This provision does not apply to maternity admissions.
Pre-admission authorization is not a guarantee that all services and charges will be paid for by the Fund. Your benefits are still subject to the terms and conditions of the Plan.
If you do not notify the Blue Cross Blue Shield MSA within the required periods of time, you will have to pay an additional $250 copayment before the Fund will pay any benefits.
Services received at the following facilities will be subject to an additional $250 copayment unless approved by Blue Cross Blue Shield MSA:
- Hospital,
- Dialysis facility, or
- Skilled nursing facility.