Providers: Download the Preauthorization/Prior-Auth Request Form
To help contain costs and ensure that the services paid for by your health plan are medically necessary and appropriate, some services require our authorization before you receive them. Failure to receive our preauthorization for the services listed below could result in coverage for the service being denied. If we do cover a service for which preauthorization was required but not obtained, the member or provider could be responsible for a penalty of 50% of the cost of the service, up to $500.
Hospital Admission Notification
All our health plans require you notify us before you have an inpatient stay for medical and behavioral health care.
Planned Hospital Admissions
If you or anyone in your family is expected to stay overnight in a hospital, call us at 800.279.4000 before you're admitted.
You will want to call at least five days in advance whenever possible to keep everything running smoothly. Since this notification is a plan requirement, your reimbursement for services may be reduced unless you notify us. Please check your policy for specific notification requirements for maternity-related admissions and emergencies.
Emergency Hospital Admissions
If you are admitted to the hospital for an emergency, notify us within 72 hours following the emergency.