2025 Blue Cross and Blue Shield Service Benefit Plan - FEP Blue Focus
Section 3. How You Get Care
How to request precertification for an admission or get prior approval for Other services:
If your facility stay needs to be extended

 

  • If your facility stay needs to be extended

If your hospital stay – including for maternity and RTC care – needs to be extended, you, your representative, your physician, or the hospital must ask us to approve the additional days. If you remain in the hospital beyond the number of days we approved and did not get the additional days precertified, then:
 
  • for the part of the admission that was medically necessary, we will pay inpatient benefits, but
     
  • for the part of the admission that was not medically necessary, we will pay only medical services and supplies otherwise payable on an outpatient basis and we will not pay inpatient benefits.