3232 or 800-336-0123 , for further information . You may also submit reconsideration as outlined in the Requests for Reconsideration section .
Member ’ s Responsibility and Additional Fees for Covered Services
You may not charge our members fees for covered services beyond copayments , coinsurance , or deductibles as described in their benefit plans . You may not charge our members contractual “ write-off ” amounts , or fees for covered services that are denied or not paid due to your failure to notify or bill Hometown Health timely , for services that you performed that were denied as not medically necessary , or for claims that were denied because of your failure to cooperate with the terms of your contract , including the prior authorization program requirements .
Charging Members for Non-Covered Services
For our Commercial and Senior Care Plus members , you may seek and collect payment from our member for services not covered under the applicable benefit plan , providing that you first obtain the member ’ s written consent for those services on a dated and signed form that is retained in your patient ’ s medical record . These services most often occur when members seek plastic surgery services at the time of a covered medical procedure , or when they have an astigmatism correcting lens implanted at the time of a covered cataract surgery . Hometown Health will not cover physician time , assistant surgeon time , anesthesiologist time , operating room and anesthesia services , and hospital charges ( including observation or inpatient services ) for services that we determine to be non-covered according to the application of the medical necessity criteria or exclusions in the benefit plan , the use of nationally recognized guidelines , or after physician peer review .
You , as a provider , should contact Hometown Health for prior authorization or a coverage determination for services for a particular member according to the prior authorization program requirements , or if you suspect that the services proposed may not be medical necessary or covered under the benefits .
In addition , for our Senior Care Plus members , Hometown Health will provide a denial of medical coverage to the member to advise them that the service is not covered . The member can then exercise their appeal rights through Senior Care Plus , if they so choose or they can proceed with the service at their expense .
Hometown Health reserves the right to retrospectively review all services billed to Hometown Health for coverage policy benefit eligibility and medical necessity . Prior authorization and benefit eligibility do not guarantee that services and benefits will be paid for that member .
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