Premera’s outpatient rehabilitation management program reviews treatment plans for physical therapy, occupational therapy, massage therapy, and some chiropractic services (except spinal manipulations).
All fully insured and OptiFlex medical plans include this program. It is available as an optional service for self-funded groups.
If you're employee needs outpatient rehab, their therapist will assess their condition and provide treatment during their first visit.
Their therapist writes a treatment plan that includes info about their condition, progress, and treatment goals. This plan shows the member, their referring doctor, and Premera how the therapist plans to help them heal.
Reviewing a member's treatment plan is an important way to make sure they’re getting effective and medically necessary care. This helps the member:
Most plans are reviewed within 24 hours.
If your treatment plan is denied, your employee and their therapist will both be notified by letter. Your employee has several options:
Typically, eviCore authorizes 4 or 6 initial visits. If the therapist determines that more treatment is needed, they will submit a treatment plan to eviCore for additional visits.
Doctors and therapists in Premera’s provider networks are familiar with this review process. If there is concern they may be unaware, your employees can share this information with them: