Central PA Teamsters

Central Pennsylvania Teamsters Health & Welfare Fund

Pre-Certification Requirements

Pre-certification is required for all non-emergency hospital admissions and surgery and most out-patient surgeries. MRI’s, CAT Scans and PET Scans do not require pre-certification. Please call the Fund Office if you have questions regarding the necessity of pre-certification in a particular situation.

Plan medical advisors make the final pre-certification determination. Aetna reviews pre-certification requests for the Plan’s medical benefits.

The pre-certification rules of the Central PA Teamsters Health and Welfare Fund govern and are separate and different from those of other Aetna plans.

If you are using a Network physician, it is the doctor’s responsibility to contact the Fund Office and follow its instructions to obtain pre-certification. If you use a non-Network provider, it is your responsibility to contact the Fund Office and follow its instructions to obtain pre-certification.

If you have emergency surgery, you or your provider must notify the Fund Office within 2 business days after treatment/hospitalization.

Please note: Pre-certification approval does not automatically mean that a claim will be approved. The Trustees reserve the right to deny benefits if subsequent information leads the Plan’s professional advisors to conclude that the treatment was not medically necessary.

To pre-certify, you must call the Fund Office at 610-320-5500, toll-free in PA at 1-800-422-8330 or toll-free nationwide at 1-800-331-0420.

Central Pennsylvania Teamsters Pension Fund
P.O. Box 15223
Reading, PA 19612-5223
Toll Free in PA:
1-800-343-0136
Toll Free in USA:
1-800-331-0420

 

Central Pennsylvania Teamsters Health & Welfare Fund
P.O. Box 15224
Reading, PA 19612-5224
Toll Free in PA:
1-800-422-8330
Toll Free in USA:
1-800-331-0420

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