On the Mend with Outpatient Rehab

Premera’s Outpatient Rehabilitation Management program makes sure you get the best care—and the right kind of care—after an illness or injury.

Outpatient rehabilitation, or rehab, benefits are part of every Premera plan. They include therapy you get outside of a hospital admission:

  • Massage therapy
  • Physical therapy
  • Occupational therapy

Ensuring your best care
Premera reviews treatment plans for outpatient rehab that are developed by therapists to make sure you’re getting care that’s both effective and medically necessary. We want you to:

  • Get the right care for your condition
  • Avoid paying for services that don’t help you recover
  • Have benefits available when you need them

What to expect
When your doctor refers you for outpatient rehab:
1. Your therapist assesses your condition and treats you at your first visit. The first 6 visits you need to treat your condition must be medically necessary, but do not need review by eviCore – Premera’s medical review partner.

2. If additional visits are needed beyond the initial 6 to treat the same condition, your therapist tells eviCore about your condition, gets authorization for additional visits, and creates a treatment plan.

3. eviCore’s medical professionals review the plan using medical best practices and clinical
guidelines to determine the medical necessity, and best duration of care.

4. Once your treatment plan is approved, you can proceed with your next visit.

Most plans are reviewed within 24 hours.

Denied? Don’t despair.
If your treatment plan is denied:

  • Your therapist can revise and resubmit the plan
  • Your therapist can review the plan with an eviCore therapist or medical director
  • You may appeal the decision