See If You Need Prior Authorization
To begin your search, enter your Member ID and the procedure code or service description.

What’s Prior Authorization?

Prior authorization – also known as pre-authorization or pre-certification – is an important checkpoint where your provider submits a request to confirm that a treatment is safe, based on medical evidence and imperative for improving your well-being. It also safeguards you against clerical errors that might result in a surprise bill from a provider.

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Making Prior Authorizations Easier, Faster

We try to make it as easy as possible for members and their care providers to look up if prior authorization is required. With the Prior Authorization Search tool, you can enter your member ID number on your insurance card and either the procedure code or service description from your provider to see if that treatment requires prior authorization.

Watch the video to learn more about using the Prior Authorization Search tool.

What You Can Do to Help with Prior Authorizations

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Plan Ahead

In addition to reviewing your insurance benefits, talk to your doctor about prior authorization early. Standard requests can take up to 15 days to review and 72 hours for urgent requests.

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Be Proactive

Be sure to update your provider if you change insurance companies or plans so they know when they need to make a request.                                                                                      

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Stay Involved

It’s a good idea to keep talking to your provider and insurance company about a prior authorization request. Your involvement is important.                                                                                                                      

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Be Curious

Using the Prior Authorization Search tool, you can look up procedures on your own or with your care provider to see if you might need a prior authorization requested before your next appointment.

When Prior Authorizations are Needed

Of the 68,000 medical service codes, only about one percent of them require prior authorization. Meaning that it’s more likely that your procedure won’t require a request. Below are some of the most common procedures and treatments that might require prior authorization.

  • Advanced radiology imaging. (PET scans, however, no longer require prior authorization.)
  • Certain medicines including injectables and intravenous therapies
  • Prosthetic supplies
  • Heart-related treatments, including surgery, advanced imaging, diagnostics and implants
  • Muscle and bone treatments, including spinal injections for pain management, surgery and fusions
  • Cancer treatment and medications
  • Molecular lab tests
  • Sleep treatments, supplies and testing
  • Radiation-related treatments and procedures
  • Transplant services
  • Some surgical procedures
  • Some behavioral treatments, such as residential treatment centers
  • Some medical equipment and devices, including wheelchairs
  • Some services might require a prior authorization to continue receiving the service after a set number of visits

Above: How a medical service code might look with a description and if it requires prior authorization.

How Prior Authorization Requests Get Reviewed 

Prior authorization requests, if needed, are a relatively straightforward process. If your provider recommends a procedure or treatment that might need prior authorization, they will check with your insurance company. The company will review the request based on whether it's covered by your plan and if it’s medically necessary.

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What’s Reviewed in a Prior Authorization Request

When a prior authorization request comes in, we need to review it to determine if that procedure or treatment is covered by your plan and is medically necessary. But what does that mean, exactly? To be considered medically necessary the procedure or treatment needs to meet a few criteria:

  • Needed to prevent, diagnose, or treat an illness, injury, condition or disease and its symptoms
  • Meet accepted standards of medicine and consider the symptoms and side effects
  • Fits the policy associated with your medical plan

To find what your plan covers, refer to your health plan information or call the number on the back of your insurance card.

Frequently Asked Questions about Prior Authorization