If providers choose to provide PT/OT treatment on the same day as the evaluation without receiving an approved authorization first, it is not guaranteed that the services will be covered by Dean Health Plan. It is
always recommended that providers first receive the approved authorization before performing treatment.
Again, if the therapy is found to not be medically necessary, then the therapy would not be covered, but the evaluation would be covered.
No, PT/OT benefit counters renew when the insurance policy renews. Therefore, it is important to first check the member’s benefits prior to submitting the authorization request. For example, some of our members’ policies renew in July, therefore all of their benefit counters reset on their policy renewal date in July. This differs from care registration, as care registration resets on Jan. 1 for all members.
NIA Magellan PT/OT Fax Number: 800-784-6864