CHP covers medically necessary care under the provider’s contract and applicable fee schedules. If a provider recommends services – including services not performed by the provider such as labs or radiology – that are not included on the fee schedule, such services will be considered non-covered services.
All non-covered services require specific information to be documented in writing and signed by the member prior to services being rendered. This is to protect both the member and the provider in the event non-covered services are disputed. Improper handling of non-covered services could result in the provider being held liable for payment of these services. A generic form advising the member will be responsible for all charges not covered by their insurance does not meet the requirement.
For laboratory and radiology services, providers must be aware of CHP’s contracted facilities and clearly communicate direction to the member regarding where to have services performed.
For your convenience, CHP offers a Patient Consent for Non-covered Services Form that covers the specific information required. This form can also be found in your copy of CHP’s Billing Manual.