Authorization For Release of Protected Health Information
At Wabash Memorial Hospital Association, we take your privacy seriously. HIPAA guidelines strictly prohibit us from disclosing or relating Protected Health Information (PHI) to non-providers without your permission. This includes spouses and children even if they are also Wabash members.
To prevent possible delays in your treatment or in servicing your medical claims, we encourage you to complete the authorization form. Please sign and return it to us promptly so your service or care will not be delayed. If you have not completed a form, please click on Authorization For Release of P H I 2013.pdf. After printing and completing the form, please mail it to Wabash Association, PO Box 1340, Decatur, IL 62525-1340.
Medical Management Services
American Health Holding (AHH) performs Medical Management services for Wabash including pre-certification of hospital admissions, chemotherapy and specialty drug therapy, MRI, PET and CT scans, high price injectibles and specialty prescription drugs, physical, occupational and speech therapy, home health care, durable medical equipment over $500 and outpatient mental health and substance abuse services. AHH health care professionals will evaluate requests for medical services and facilities according to national benchmarks, guidelines and criteria under the provisions of your Wabash benefit plan. AHH will determine the appropriateness, medical need and efficiency of requested services and direct providers and members toward the most cost-effective quality treatment available while continuing to monitor your care to assure quality and appropriateness of your overall treatment plan.
Newborn’s and Mother’s Health Protection Act of 1996
Under Federal law, group health plans and health insurance issuers offering group health insurance coverage generally may not restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a delivery by Cesarean section. However, the plan, or issuer may pay for a shorter stay if the attending provider (e.g., your physician, nurse, midwife, or physician assistant), after consultation with the mother, discharges the mother or newborn earlier.
Also, under Federal law, plans and issuers may not set the level of benefits or out-of-pocket costs so that any later portion of the 48 hour (or 96 hour) stay is treated in a manner less favorable to the mother or newborn than any earlier portion of the stay.
In addition, a plan or issuer may not, under Federal law, require that a physician or other health care provider obtain authorization for prescribing a length of stay of up to 48 hours (or 96 hours). However, to use certain providers or facilities, or to reduce your out-of-pocket costs, you may be required to obtain pre-certification. For information or precertification, contact your plan administrator.
Women’s Health and Cancer Rights Act of 1998
Under the Women’s Health and Cancer Rights Act, members eligible for medical / surgical benefits relating to mastectomies have coverage provided for reconstruction of the breast operated on, and/or surgery/reconstruction of the other breast, and/or prosthesis and treatment of physical complications at all stages of mastectomy.
Governing Law Notice
Many different laws apply to our Plan. Some additional provisions may apply to your situation because the law requires them. This can affect your rights and responsibilities even if the laws are not included or explained in this document. The principal law that applies is Title XVIII of the Social Security Act by the Center for Medicare and Medicaid Services (CMS). In addition, other Federal laws apply and, under certain circumstances, the laws of the State (s) in which you reside may apply.
When we make decisions about employment of staff, we do not discriminate based on a person’s race, disability, religion, sex, sexual orientation, health ethnicity, creed, age or national origin. All organizations that provide Medicare Managed Care Plans and Health Care Prepayment Plans, like Wabash Association, must obey Federal laws against discrimination, including Title VI of the Civil Rights Act of 1964, the Rehabilitation Act of 1973, the Age Discrimination Act of 1975, the Americans with Disabilities Act, all other laws that apply to organizations that receive Federal funding and any other laws and rules that apply for any other reason.