Medi-Call Treatment Pre-Certification

SC State Health Plan members please note: before you have certain treatment or care, you may need to call us for pre-certification. Please call us before you receive these services, or 48 hours after an emergency. If you don't, you'll have to pay $200! And the costs you have for your treatment will not go towards your out-of-pocket limit. Just call Medi-Call at 803-699-3337 or toll free 1-800-925-9724.

Procedures that require pre-certification:

  • All hospital admissions.
  • Pregnancy (must call within first trimester or there will be an additional $200 penalty).
  • Any non-emergency surgery (e.g. septoplasty, hysterectomy or sclerotherapy) you have in a hospital, free-standing clinic or ambulatory surgical center.
  • Any non-emergency surgery you have on your foot or knee in your doctor's office.
  • All admissions for obstetrical and sick newborn services.
  • Hospitalizations that are longer than the length of stay that Medi-Call previously authorized.
  • Chemotherapy or radiation therapy.
  • In vitro fertilization for you or your spouse.
  • Extended care services, like hospice, home healthcare, skilled nursing facility or durable medical equipment.
  • Any medical treatment involving inpatient rehabilitative services and related outpatient physical, speech and occupational therapies, a second surgical opinion and extended care.
  • Organ transplant, bone marrow transplant or other stem cell rescue or tissue transplant that are covered in your health plan.
  • A pre-certification request for any procedure that may potentially be considered cosmetic in nature (e.g. blepharoplasty, reduction mammoplasty, TJM or other jaw surgery, etc.), must be received in writing by Medi-Call seven days before surgery.

To check claims status, view an explanation of benefits (EOB), check eligibility and benefits and much more, log in to My Health Toolkit®.