Is pre-notification required prior to seeking treatment for a medical condition?

Yes, pre-notification is required prior to some treatments and services.

Members or providers must pre-notify Impact for any of the following treatments to be eligible for sharing:

• Cancer treatment

• Elective cardiac procedures

• Inpatient/outpatient surgery

• Non-emergency hospital/facility admission

• Organ/tissue transplant services

Providers must pre-notify by calling (855) 378-6777. In the event of emergency/urgent care, the member or provider must provide notification within 72 hours of when medical care was given. Pre-notification of medical treatment and/or service does not guarantee eligibility or Sharing.

Pre-notification enables Impact to inform the member of provider options and potential incentives. 

If a member or their provider does not pre-notify Impact of the illness, condition, treatment, procedure or event, the member will be subject to an additional provider fee of $1,000.