Advocate Health Care
Benefits

 


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AdvocateCentered EPO Frequently Asked Questions (FAQs)

Q. Why should I submit a Prior Authorization for Out of Network Request Form?

A: You should submit a Prior Authorization form:

  • When Advocate does not provide the service you require.
  • For the following types of services: fertility, oral surgeons and dentists, chiropractic providers and physical therapy providers.
  • When a covered family member is attending school out of the area and has recurring medical needs such as physical therapy, allergy shots, behavioral health, etc.

Q: How do I submit the form?

A: We recommend you fill out and submit the form online at advocatebenefits.com>Benefits Information>EPO Concierge. You may also call (847)-699-4311 to contact a transition of care specialist and we will provide an answer within 2 business days. A Medical Director will be consulted on all requests to determine if the same services can be provided by Advocate Centered provider.

Q: If I am authorized to receive care outside the Advocate Centered Network, will my benefits cover the costs charged by a non-network provider?

A: If you’re authorized to receive care outside the Advocate Centered Network, your benefits will provide coverage at the same level as if you received care in-network. We strongly recommend you tell your authorized non-network provider that your plan benefits will only pay reasonable and customary charges. You may be billed for any amount above these rates if your provider charges more, so make sure you discuss and agree on charges with your provider before you receive care or treatment.

For more information, call the EPO Concierge Service at 1.855.EPO.ADVO (1.855.376.2386), Monday through Friday 7am - 7pm and Saturday's 9am - 2pm.