SSS

SSS

Documents are valid:

  • Physician’s Order - 6 months; must submit original medical order.
  • Authorization or eligibility - 30 days from issued date.
  • Pre-Certification - 30 days from issued date.

If the procedure is not performed within 30 days after issuance of the pre-certification you may reapply without having to submit documents.  If the determination was issued 90 days or more, SSS requires you submit all documents to the medical plan for evaluation.

Studies that require authorization:

  • PET-CT
  • Some coverage includes MRI, CT and Nuclear Medicine studies (SSS requires eligibility details be requested by us through SES via Internet).

Studies that SSS requires and depending upon their eligibility may require authorization:

  • MRI
  • CT
  • Ultrasound
  • Vascular Ultrasound
  • DEXA

Major Medical:
It is an extension of the basic coverage (the patient pays for this extension).  The patient is charged the contracted rate (this exception is made by San Patricio MEDFLIX) and the patient seeks reimbursement from the health plan.

SSS Optimo

Authorization required by SSS Optimo:

  • MRI
  • MRA
  • CT
  • CTA
  • PET-CT
  • Nuclear Medicine

Eligibility Required:

  • Ultrasound
  • Vascular Ultrasound
  • DEXA