Do I need a prior authorization?
Some in-network medical services are covered only if your doctor or other health care professional gets approval in advance from your plan – this is called prior authorization, prior approval, or pre-certification.
To see if a specific service requires a prior authorization, follow the steps below:
- Select Benefits & Coverage, then What’s Covered.
- Under the Medical tab, go to the dropdown menu titled Service you may need.
- Select the type of service you are looking for.
- Check the chart(s) to see if prior authorization is required. You may need to scroll down to view all of the information you need.
Your primary care physician or specialist may obtain prior authorization for you by calling us at 1-800-664-2583 (TTY 711).
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Approval is not a guarantee of payment. The benefits of your policy at the time of service are still applied, including in-network vs. out-of-network benefits, exclusions, limitations, copayments, deductibles and/or coinsurance. A service or treatment may be medically necessary but not covered under your specific health benefits plan.