Preauthorization  (simple)
Plan guarantees payment of all claims submitted by Provider for Services that the Plan has pre-authorized.  Plan further agrees to conduct its utilization management programs in good faith and make its utilization decision in a fair and consistent manner.

When a Covered Person requires a non-emergency hospital admission, Covered Person is responsible for securing authorization for such admission prior to the admission.  In case an emergency admission occurs, Covered Person is responsible to notify Payer.  Payer shall pay for emergency care services provided to Covered Persons by Participating Hospital at the negotiated or billed rate for any medical screening examination or other evaluation required by state or federal law which is necessary to determine whether an emergency medical condition exists.  Payer shall not require prior authorization for treatment of any emergency medical condition or for Covered Services arising after the initial medical screening examination and immediately necessary stabilizing treatment.