POS Members:
Some Tier 2 (Aetna Open Choice) and Tier 3 (out-of-network) services require precertification before you receive services. It is your responsibility to make sure that you receive precertification.
PPO Members:
Some Tier 1, Tier 2 and Tier 3 services require precertification before you receive care. It is your responsibility to make sure that you receive precertification.
Services that require precertification:
Log in to your Sharp Health Plan online account to read your benefit matrix and find out which services require precertification.
Requesting precertification:
To request precertification, have your doctor complete the POS/PPO
Precertification Form and fax it to Sharp Health Plan.
If you do not receive required precertification, you may be required to pay 50% of the amount Sharp Health Plan pays the provider for that service, rather than the coinsurance amount listed on your benefit matrix. The 50% payment will not count toward
your deductible or annual out-of-pocket maximum. If the service is not found to be medically necessary, you will be required to pay 100% of the charges.