We are committed to working in partnership with your provider to ensure you get the care you need.
We cover many treatments and services. Some, however, require prior authorization. Prior authorization is an approval you must get before you receive certain treatments, services, medical equipment, or certain medications. To see if a particular service requires prior authorization, please review the:
Important: This list is for reference only. Please consult with your doctor to determine whether or not your specific medical, surgical, or behavioral health service requires a prior authorization.
To determine approvals for care, a Utilization Reviewer uses approved criteria to analyze the request and the clinical information provided. If these meet the medical necessity criteria, the Utilization Reviewer may approve the services. If they do not, the case will be referred to the Medical Director for review. Our prior authorization and review process is determined by our official policy.