If you have a Point of Service (POS) plan, some Tier 2 - Aetna/ or Out-of-Network services require precertification before you receive services. It is your responsibility to make sure that you receive precertification. To request precertification, have your doctor complete the POS Precertification Form and fax it to Sharp Health Plan.
If you do not receive required pre-certification, 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 Benefits 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. You can log onto SharpConnect to read your Benefits Matrix and find out which services require precertification.