Hospital Inpatient Services

These services include an overnight stay in a hospital.  You need to get an approval from us ahead of time each time you stay overnight in a hospital.  You do not need an approval for an emergency or for the birth of a baby.

Your PCP can send you to any hospital in the West Virginia Family Health (WVFH) network.  See the Provider Directory for a list of the hospitals that work with us.  Go to the nearest hospital during an emergency.

What is a covered service?

  • A hospital room with two or more beds
  • Care in special units
  • Operating rooms
  • Delivery rooms
  • Special treatment rooms
  • Supplies
  • Medical testing
  • X-rays
  • Drugs the hospital staff give you during your stay
  • Giving you someone else’s blood
  • Blood products
  • Radiation therapy
  • Chemotherapy
  • Dialysis treatment
  • Meals and special diets
  • General nursing care
  • Special duty nursing for medical reasons
  • Anesthesia
  • Respiratory therapy
  • Bariatric surgery
  • Diagnostic care
  • Therapeutic care
  • Rehabilitation care
  • Overnight hospital stay for dental work because of other medical problems or because serious dental work is needed
  • Setting up discharge planning, including continuing care, if needed
  • Surgery to remove a breast or dissect a lymph node
  • If you have a breast removed or lymph node dissected, you do not need an OK from us to decide how much time you will spend in the hospital after surgery
  • All problems from a breast removal surgery (including lymphedema)
  • Surgery to reconstruct.  This includes prosthetics (false body parts) or surgery to make your breasts look the same after a breast is removed.  We also cover manmade body parts to replace real body parts that are missing.

Limits

We do not cover any of the above services for adults in facilities for mental illness.