Medical services requiring preauthorization
To protect you from unnecessary out-of-pocket expenses and to let you know whether proposed medical services or equipment meet our criteria for insurance coverage, you must obtain our preauthorization; that is, you or your physician must call us at (800) 279-4000 before you receive certain medical services or medical equipment.
Here's a complete list of the services that require our preauthorization. If your doctor recommends any of these services, please call us before you receive them:
- Chronic pain management and treatment of chronic pain syndromes
- Cochlear implant evaluations, services, and procedures
- Durable medical equipment
- Genetic counseling and testing
- Home health care
- Hospice care
- Mental health and substance abuse evaluations, services, and treatment
- Nutritional counseling for life threatening illnesses such as eating disorders
- Physical, speech, and occupational therapy services
- Psychological and neuropsychological testing
- Reconstructive or plastic surgery
- Second opinion consultations related to diagnoses, treatments, or surgeries
- Skilled nursing facility care
- Skilled rehabilitation services
- Transplant evaluations, services, and procedures
- Treatment of temporomandibular disorders (TMD)
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Why call first?
If you don't obtain preauthorization when you're required:
 | You won't know in advance if a service will be covered. | | You won’t know if any reimbursement limits apply. | | You could be responsible for the entire bill because we are not obligated to reimburse you when you don’t obtain our preauthorization. |
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