There are multiple options available when you need an outpatient surgery or procedure on both the EPO Network and Plus Network.
On the EPO benefit tier you can have your services provided at:
- Kern Medical by either your doctor (if he or she has privileges with the hospital) for no copay
- A contracted in-network hospital in the outlying areas of Kern County for a $150 copay
- An EPO Network Ambulatory Surgical Center for a $50 copay
Your doctor will submit an authorization request for the procedure, specifying where the surgery is to be performed at the EPO benefit tier. If a location is not selected, the authorization will default to the EPO Network hospital facility, Kern Medical.
All surgeries and procedures require authorization. Authorizations must be obtained prior to receiving care or your services will not be covered.
On the Plus benefit tier you can have your services provided at:
- A Plus Network Hospital by a contracted doctor
- A Plus Network Ambulatory Surgical Center
You will be responsible for a 20% coinsurance for all charges related to the use of a Plus Network facility once the annual deductible is met.
To choose a Plus Network facility, you must contact Kern Legacy to notify the Plan that you are opting to use your Plus benefit. At the time that you elect your Plus Benefit, the Plan will request that your doctor submit an authorization request so that the Plan can review and determine medical necessity. Services must be authorized prior to services being rendered. Services not authorized by the Plan will not be covered.