Requests & Referrals (Utilization Management)

Virginia Premier understands that you may need certain medical services from time to time. We are committed to working with you and your provider to obtain the necessary medical services that you may need.

What services does this include?

Your doctor may need to send in a request/referral for:

• Hospital admissions
• Medical equipment
• Medical procedures
• Home health

What should I do if I need any of these services?

Please contact your doctor for assistance.

What happens if the request/referral is not approved by Virginia Premier?

• The request for medical services may be denied due to lack of medical necessity
• You may request an appeal within 30 days of the denied service. Refer to the Complaints and Grievances section of your member handbook
• Virginia Premier will review your request and refer it to a medical advisor who did not make the first decision
• You will be notified of the results by a letter within 30 days