Services Requiring Preauthorization
- Advanced imaging scans (e.g. MRI, CT scans) of the neck and spine provided on an outpatient basis. Such scans provided while you are inpatient or provided as part of emergency care are not subject to preauthorization. *
- Arthroscopic Procedures (Knees, Hips, and Shoulders)
- Autologous Chondrocye Implantations
- Behavioral Health Care:
- Partial hospitalization
- Intensive outpatient
- Residential services
- PET Scans
- MRA Scans
- Back surgeries for pain
- Continuous glucose monitors
- Dialysis (outpatient and home dialysis)
- Invasive Back Procedures
- Durable medical equipment with a purchase OR rental price greater than $1,000
- Cochlear Implants
- Elective and/or planned inpatient stays prior to admission
- Electroconvulsive Therapy
- Gastric Neurostimulators
- Genetic testing
- Home Health Services – Including Wound Care
- Hyperbaric Oxygen Therapy
- Impression and Customer Preparation; Speech Aid Prosthesis
- Inpatient and outpatient facility usage associated with any dental services
- Insulin Pumps
- Knee Scooters
- LINX
- Minimally Invasive Direct Coronary Bypass Grafts
- Nuclear Medicine – Cardiology (Myocardial Perfusion Imaging, Tomographic/Planar)
- Nonsegmental pneumatic appliance
- Oncology Related Services:
- Prior to any initiation of treatment we require notification of diagnosis and treatment plan - Effective April 1, 2018
- To prior authorize these services call WEA Trust at 1.800.279.4000
- Orthognathic Procedures *these are still not covered for WEA Trust members in the State Health plan
- Osteochondral Autograft Knee, Open
- Physical, speech, and occupational therapy services (excluding evaluations)
- Pneumatic Compressor
- Proton B Therapy
- Psychological and neuropsychological testing [Use this form when requesting authorization]
-
Reconstructive or plastic surgery such as, but not limited to:
- Abdominoplasty
- Blepharoplasty and ptosis repair
- Brachioplasty
- Breast augmentation, lift, or other breast reconstructive surgery
- Panniculectomy
- Thighplasty
- Treatment of varicose veins
- Segmental pneumatic appliance
- Skilled nursing facility care
- Skilled rehabilitation services
- Sleep Studies
- Surgical Sleep Disorder Treatment
- Specialty drugs and high-cost drugs with unique monitoring or delivery needs
- Tens Unit
- Total Joint Replacement
- Transmagnetic Stimulation
- Transplant evaluations, services, and procedures
- Treatment of temporomandibular disorders (TMD)
- UAS Therapy
- Whole Body Imaging
* All advanced imaging scans require preauthorization for State Health Plan members.