Part C Coverage Decisions & Prior Authorization

CHRISTUS Health Plan ultimately decides whether to authorize, approve and pay for proposed medical care. As a member of the CHRISTUS Health Plan Generations or Generations Plus (HMO) plan, you have the right to ask us to pay for services you believe should be covered.

If you are ever unsure of what will be covered under this plan, you can request a coverage decision from us before receiving medical services. We will also assist you if you believe your physician or provider is refusing to provide necessary medical services or care.

Disclaimer
CHRISTUS Health Plan Generations is an HMO plan with a Medicare contract. Enrollment in CHRISTUS Health Plan Generations depends on contract renewal. You must continue to pay your Part B premium. The benefit information provided is a brief summary, not a complete description of benefits. For more information, contact the plan. Limitations, copayments, and restrictions may apply. Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year. Other pharmacies/physicians/providers are available in our network. Medicare beneficiaries may also enroll in CHRISTUS Health Plan Generations (HMO) through the CMS Medicare Online Enrollment Center located at medicare.gov. A sales person will be present with information and applications. This information is available for free in other languages. For accommodations of persons with special needs at sales meetings, call 1-844-282-3026, 711 for TTY users). Open seven days a week, 8 a.m. to 8 p.m., local time, from October 1 – March 31, and Monday – Friday, 8 a.m. to 8 p.m., local time, from April 1 – September 30. Interactive voice response system or similar technologies for Saturdays, Sundays and Federal Holidays (messages must be returned within one (1) business day). CHRISTUS Health Plan Generations (HMO) Contract #H1189.

Notice
CHRISTUS Health Plan does NOT require authorization for in-network behavioral health services. If you have any questions, please call Member Services at:

Member Services: 844-282-3026 ( 711 for TTY users).

  • How to Request a Coverage Decision

  • Expedited Coverage Decisions

  • What to Do When Coverage Decision is Denied

  • Prior Authorization

Last Updated: 01/02/2021