None of my doctors are in the network. So you are saying they will all join if we call Narus Health?

No. Doctors have various reasons for not joining networks. If you want to nominate a doctor to the network, you will use the link on the PHCS website. You may go to doctors who do not participate in the PHCS network. If you have questions or issues, or if you receive a balance bill, you would then call Narus.

How do I know what amount I’m supposed to pay to my providers and the facilities?

Contact Narus Health at the number on your ID card. Narus Health will assist you in reviewing any bills you receive from your providers and in understanding your Lucent Health Explanation of Benefits.

What should I do if I receive a balance bill?

Contact Narus Health at the number on your ID card. Narus Health will work with the plan to resolve the balance bill. A. Facility - If the balance bill is from a facility, Narus Health will work with the Patient Advocacy Center (PAC) to educate the provider on the plan payment and negotiate, if necessary, to settle the balance bill. You may be required to sign documents allowing the PAC to represent you while it resolves the bill. The PAC will keep you informed on the status until an agreement is reached. Please note, the PAC process will take an average of 60 days to complete. B. Physician and Ancillary - If the balance bill is from a physician or ancillary provider, Narus Health will educate the provider on the plan payment and work to settle the bill. Narus Health will keep you informed on the status during this process. Please remember that you will be responsible for any amount represented as “patient responsibility” on the Lucent Health EOB. Make sure to pay your patient responsibility to the provider or contact the provider to set up a payment plan.

What is a balance bill?

If you receive a bill from a service provider that represents an amount owed by you that is greater than the amount represented on your Lucent Health Explanation of Benefits (EOB) as your “patient responsibility” for the same services, then you have received a balance bill.

What should I do if my physician has pre-certified my procedure but the facility where the procedure is scheduled says it will not accept my insurance and I will have to pay upfront if I do not want to cancel the procedure?

Contact Narus Health at the number on your ID card. Narus Health will collect your name, member ID number, facility name and contact information, physician’s name and contact information, type of procedure, and date of procedure. Narus Health will coordinate with the plan on your behalf and let it know that the facility is not accepting the insurance. The plan will contact the facility and, if needed, begin pre-service negotiations. Narus Health will keep you informed on the status of the procedure.

What do I do if my provider will not call or has not called the utilization review company to precertify a procedure?

Contact Narus Health at the number on your ID card. Narus Health will collect your name, member ID number, physician’s name and contact information, type of procedure requested, and expected date of procedure. Your provider will be notified when the pre-certification is complete and authorization has been granted.

What are my options for appeal if pre-certification denies my care at my chosen provider?

You may appeal a denial. However, since your plan is not limited to a network of providers, denials would not be due to a provider being “out of network.” A denial would be based on a procedure not being covered by the plan benefits, not being medically necessary, etc.

During an emergency situation, where pre-certification cannot be performed, is there any risk of not being covered by health insurance?

No. Emergencies do not require pre-certification.

How do I know what procedures need to be pre-certified?

A list of procedures requiring pre-certification are on the back of your ID card, along with the number for your provider to call to pre-certify them.

What procedures/services require pre-certification?

All inpatient and outpatient procedures or surgeries performed in a facility (as defined above) require pre-certification and authorization. In addition, there are other services listed in the utilization review section of your plan document that will require pre-certification and authorization. These include but are not limited to: inpatient and outpatient behavioral health and chemical dependency; home healthcare and hospice care; physical, occupational and speech therapy; complex imagining (MRI, PET, CAT scan, etc.); and chemotherapy and radiation therapy. A copy of your plan document can be found on the mylucenthealth.com portal. Your physician should contact the pre-certification number listed on your ID card to have the procedure pre-certified. Narus Health will check for medical necessity and advise the provider if the requested service is authorized by the plan. PLEASE NOTE: Narus Health recommends the provider start the pre-certification process 5-7 days prior to the scheduled service date. Providers should call Lucent Health to confirm your eligibility and benefits at 877-214-2129.

FAQs Archive - Page 7 of 8

None of my doctors are in the network. So you are saying they will all join if we call Narus Health?
No. Doctors have various reasons for not joining networks. If you want to nominate a doctor to the network, you will […]

Continue reading
How do I know what amount I’m supposed to pay to my providers and the facilities?
Contact Narus Health at the number on your ID card. Narus Health will assist you in reviewing any bills you receive from your […]

Continue reading
What should I do if I receive a balance bill?
Contact Narus Health at the number on your ID card. Narus Health will work with the plan to resolve the balance […]

Continue reading
What is a balance bill?
If you receive a bill from a service provider that represents an amount owed by you that is greater than the amount represented […]

Continue reading
What should I do if my physician has pre-certified my procedure but the facility where the procedure is scheduled says it will not accept my insurance and I will have to pay upfront if I do not want to cancel the procedure?
Contact Narus Health at the number on your ID card. Narus Health will collect your name, member ID number, facility name […]

Continue reading
What do I do if my provider will not call or has not called the utilization review company to precertify a procedure?
Contact Narus Health at the number on your ID card. Narus Health will collect your name, member ID number, physician’s name […]

Continue reading
What are my options for appeal if pre-certification denies my care at my chosen provider?
You may appeal a denial. However, since your plan is not limited to a network of providers, denials would not be […]

Continue reading
During an emergency situation, where pre-certification cannot be performed, is there any risk of not being covered by health insurance?
No. Emergencies do not require pre-certification.

Continue reading
How do I know what procedures need to be pre-certified?
A list of procedures requiring pre-certification are on the back of your ID card, along with the number for your provider […]

Continue reading
What procedures/services require pre-certification?
All inpatient and outpatient procedures or surgeries performed in a facility (as defined above) require pre-certification and authorization. In addition, there […]

Continue reading

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