Covered Services

COVERED SERVICES

COVERED SERVICES

 

Meridian does not require a referral for covered services. Some care may only need your doctor to tell Meridian about it before you can get it. Some care needs prior approval before you can get it. Click the links below to see what is covered. Call

888-437-0606

for more information. 

 

.

  • Allergy Testing
  • Audiology Services and Testing (hearing tests; hearing aids need prior approval)
  • Barium Enema
  • Bone Densitometry Studies
  • Brain Surgery*
  • Bronchoscopy
  • Cardiac Procedures*
  • Cardiac Stress Test
  • Cardiograph
  • Chemotherapy/Infusions*
  • Chiropractic Care (in-network only†)
  • Cleft Lip Repair*
  • Colposcopy after an Abnormal Pap
  • DME/Prosthetics and Orthotics = $1000 (in-network only†)
  • Electrocardiography
  • Endoscopy
  • Gastroenterology Diagnostics
  • GI Procedures*
  • Habilitative Therapy Services (21 and under)
  • Hernia Repair*
  • Intravenous Pyelography (IVP)
  • Life-Threatening Emergencies (ER Screening)
  • Lymph Node Surgery*
  • Mammogram and Pap Test
  • Myoview Stress Test
  • Nerve/Tendon Surgery*
  • Neurology and Neuromuscular Diagnostic Testing
  • (EEGs, 24-Hour EEGs and EMGs)
  • Non-Invasive Vascular Diagnostic Studies
  • Obstetrical Observations
  • Orbital Procedure*
  • Orthopedic Replacement/Revision*
  • Outpatient Mental Health Care
  • Physical, Occupational and Speech Therapy (evaluations only)
  • PT/OT/ST for first 24 visits age 21+*
  • Pulmonary/Vascular Procedures*
  • Routine Lab
  • Routine X-Ray (CT Scan, MRI, MRA, PET Scan, DEXA, HIDA Scans)
  • Sigmoidoscopy or Colonoscopy
  • Skin Graft*
  • Sleep Studies (Facility only)
  • SPECT Pulmonary Diagnostic Testing
  • Spleen/Liver Procedure*
  • Ultrasounds
  • Urgent Care
  • Video EEG*
  • Vision/Glasses
  • Voiding Cysto-Urethrogram
  • 23-Hour Observation for In-Network Facilities Only (prior approval needed for elective services)

 

*These outpatient surgeries do not need prior approval when done at in-network facility. Out-of-network facilities need prior approval. 

†All DME supplies and chiropractic services should be given by an in-network provider.

 


  • Dialysis
  • Outpatient Radiation Therapy
  • Maternity Care/Delivery
  • Outpatient Mental Health Care. Please call the Meridian Behavioral Health department for help 888-222-8041
  • Specialist Office Visits/Consults (to help us coordinate care)


Specialty Network Access Form (SNAF) for Hurley Hospital and Michigan State University must follow the SNAF process. Meridian must fill out a referral form for the doctor.

 


  • Ambulance Transportation (non-emergent)
  • Anesthesia (when performed with radiology testing)
  • Any Out-of-State Service (doctor or facility)
  • Bariatric Surgery
  • Cardiac and Pulmonary Rehab
  • Chemotherapy and Specialty Drugs
  • May need review under the medical or pharmacy benefit
  • DME/Prosthetics and Orthotics more than $1,000
  • Elective Inpatient/Surgeries and Skilled Nursing Facility Stays
  • Elective Hospital Outpatient Surgery
  • Genetic Testing
  • Hearing Aids
  • Hereditary Blood Testing (e.g., BRCA for breast and ovarian cancer)
  • Home Health Care
  • Hospice and Infusion Therapy
  • Infusions
  • Specialty Drugs (covered under the medical benefit)
  • Weight Management (before bariatric surgery)


All emergency inpatient admissions, surgeries and out-of-network 23-hour observations need corporate prior approval. For emergency approval, Meridian must be told within the first 24 hours or the next business day. 

Out-of-network hospitals must tell Meridian at the time of stabilization and ask for prior approval for all post-stabilization care.

 


  • Aqua Therapy
  • Children's Speech, Physical and Occupational Therapy covered under School Based Services
  • Community mental health services
  • Convenience Items
  • Cosmetic Services
  • Functional Capacity
  • Infertility Services
  • Any other service otherwise not covered by Medicaid

Your doctor may send any notice or prior approval to Meridian via fax: 313-463-5254 or by phone: 888-322-8844.

 


Page Last Modified: 1/9/2018 1:37:46 PM