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Covered Benefits
If you are an MPI Health Plan PPO Participant (Anthem Blue Cross) wondering whether a medical service or procedure is a covered benefit under the Plan, please see the Active and Retiree Health Plan Summary Plan Descriptions (SPDs) for a list of covered services and non-covered services. Also, please keep in mind that the procedure or service must be deemed “medically necessary” to be covered by the Health Plan. (See 2013 Active Health Plan SPD, p. 42 for more detail.)

 
Preauthorizations
MPI does not require preauthorizations for the payment of procedures or services. (See Active and Retiree Health Plan SPDs.)

Nevertheless, if you or your physician seeks pre-authorization for a procedure or service, click on the appropriate form below, then complete and return it to MPI’s Medical Review Department.

You should receive an official response by mail within fourteen days.
Mail to:
Medical Review Department--Confidential
MPI Health Plan
P.O. 1999
Studio City, CA 91614-0999

Fax to:
(818) 766-6532
Preauthorization (generic)
Ambulance Questionnaire
Bone Stimulator Questionnaire
Continuous Passive Motion Request
Knee Brace Questionnaire
Physician’s Sleep Study Questionnaire
Speech Therapy Questionnaire
Wig/Prosthesis Certification