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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:

1. Select Benefits & Coverage, then What’s Covered.
2. Under the Medical tab, go to the dropdown menu titled Service you may need.
3. Select the type of service you are looking for.
4. 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).

To view the status of a referral that your doctor or other health care professional submitted, select Benefits & Coverage then Authorizations & Referrals.

To view the status of a prior authorization that your doctor or other health care professional submitted, select Benefits & Coverage then Authorizations & Referrals.

Behavioral health services, including mental health and substance abuse services, will never require a referral.

For other services, some plans require you to get a referral from your Primary Care Physician before you see a specialist. For more information on which specific services require a referral to see a specialist, the following options may be available to you:

1. View your Summary of Benefits & Coverages (SBC) and search for “referral.” This feature is not available to all members.
2. Use our Email Us or Chat tools and select Benefits to ask a Member Services Representative if the service requires a referral.

To view the status of a referral that your doctor or other health care professional submitted, select Benefits & Coverage, then Authorizations & Referrals.

To view the status of a prior authorization that your doctor or other health care professional submitted, select Benefits & Coverage, then Authorizations & Referrals.

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:

1. Select Benefits & Coverage, then What’s Covered.
2. Under the Medical tab, go to the dropdown menu titled Service you may need.
3. Select the type of service you are looking for, then Show Coverage Details.
4. 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).

Behavioral health services, including mental health and substance abuse services, will never require a referral.

For other services, some plans require you to get a referral from your Primary Care Physician before you see a specialist.

For more information on which specific services require a referral to see a specialist, the following options may be available to you:

1. To view plan documents, select Document Center, then Benefits & Coverage. From there, some members¹ may be able to access their Summary of Benefits & Coverages (SBC) and search for “referral.”
2. Use our Email Us or Chat tools and select Benefits to ask a Member Services Representative if the service requires a referral.