Hospitals and surgeries

This section explains how hospitals work with your health plan to provide you with services.

Q: What hospitals accept my health plan?

Like doctors, hospitals may accept some of our Priority Health plans but not others. You can find out which hospitals accept your plan by using our Find a Doctor directory, which lists doctors, mental health professionals, hospitals, pharmacies, medical supply providers, ambulance services and other health care providers in your health plan's network. We are always adding hospitals, so check back from time to time.

Q: Can I find out about the quality of care at my hospital?

Yes. You can find ratings of the quality of care that patients receive in the Hospital Quality section. The ratings cover how the hospitals cared for patients with heart attacks, heart failure, pneumonia or surgery.

Q: Do I have to get prior approval for surgery from Priority Health?

If you decide you do need surgery or will be entering the hospital, you may need to work with your primary care provider – or give us a call – to get prior approval. Our online surgery decision support program can you make informed decisions about your treatment options when considering surgery.

Q: What if I need reconstructive surgery following surgery for breast cancer?

In compliance with the Women's Health and Cancer Rights Act of 1998, Priority Health will consult with you to determine coverage for these services:

• Reconstruction of the breast on which a mastectomy was performed
• Surgery and reconstruction of the other breast to produce a symmetrical appearance
• Prostheses and treatment of physical complications at all stages of the mastectomy, including lymph edemas

Q: How do I know what's covered for reconstructive surgery and what the cost will be?

The coverage for reconstructive surgery following breast cancer is consistent with the other benefits under your Priority Health plan. The Schedule of Copays and Deductibles and any riders included in your Priority Health plan give you more specific information about your costs for these benefits.

Q: Does Priority Health need to approve the medical services I receive in advance?

For some services you will need a letter of approval (pre-authorization) from us before you can receive care. Your doctor will probably request the authorization for you. Check this list of the types of services that generally need prior authorization from us before they can be covered. Or you can contact Priority Health to find out, since we have many different benefit plans.