Insurance doesn’t cover every service a provider may recommend. For example, PEHP does not pay for services that are cosmetic, experimental or investigational, or not considered medically necessary. For non-covered services, get a price quote and look into using HSA or FLEX funds.

Make sure every person, facility, and service involved in your care is in your network. Just because your doctor is in your network, don’t assume the lab he/she uses is too. Be sure to verify. If you get medical equipment – such as a brace or sling – at the doctor’s office or hospital, it will likely be billed by a different provider. Make sure that provider is in your network. If your doctor refers you elsewhere for services? Always verify.

Some services require preauthorization. To get it, you or your doctor must call PEHP. Most doctors know how and when to do this, but be sure to verify with your doctor or us. Otherwise, your benefits could be reduced or denied, potentially costing you thousands of dollars. Genetic testing is commonly overlooked. Learn More About Preauthorization.