If your medical condition requires a fast decision, you can request an expedited coverage decision, also known as an expedited determination. Expedited coverage decisions can only be requested for medical care you have not yet received and because using the standard timeline could cause serious harm to your health, life or ability to function.
There are two ways to request an expedited coverage decision:
- If your provider notifies us that you need a fast decision (orally or in writing), we will automatically provide an expedited coverage decision.
- If you request the expedited decision without a physician’s notification by calling 1-844-282-3026, CHRISTUS Health Plan will decide if the standard time could jeopardize your health, life or ability to regain maximum function. If we decide that your condition doesn’t meet requirements for a fast decision, we will call your provider and send a letter notifying you and your provider that the standard timeline will be followed.
For expedited coverage decisions, CHRISTUS Health Plan will provide a decision within 72 hours of receipt.
Open seven days a week, 8:00 a.m. to 8:00 p.m., local time, from October 1 – March 31, and Monday – Friday, 8:00 a.m. to 8:00 p.m., local time, from April 1 – September 30. A voice response system is available after hours.