WebCopayment for Ambulatory Surgical Center Services $200.00. Prior Authorization Required for Ambulatory Surgical Center Services. Prior authorization required. Outpatient Substance Abuse Care. In-Network: Copayment for Medicare-covered Individual Sessions $45.00. Copayment for Medicare-covered Group Sessions $45.00. WebFor anything else, call 1-800-241-5704. (TTY/TDD: 711) Monday through Friday. 8:00 a.m. to 5:00 p.m. EST. Have your Member ID card handy. Providers. Do not use this mailing address or form for provider inquiries. Providers in need of assistance should contact provider services at 800-241-5704 (toll-free). Reporting Fraud.
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