Not every service or drug needs preauthorization, and the lists may be different for different plans. Look at your plan documents (find them on your plan’s website) for the list that applies to your plan.
Preauthorization may seem like a lot of red tape. That’s not the intention. Rather, preauthorization can:
Always ask your doctor if a drug or treatment requires preauthorization. Your doctor will know (or know how to find out) what services and medicines need it. And, in most cases, your doctor’s office will contact the health plan to get preauthorization.
When in doubt, contact your health plan yourself. If you do not get preauthorization, then the medical service or drug may not be covered or may cost you more.*
*What you pay for a service or drug covered by your plan depends on your plan’s deductible, copayments, and/or coinsurance. Some drugs have limited quantities. Your doctor will need to request preauthorization again after you reach the limit.
Sometimes you will see a prescription, service or treatment that your doctor recommends needs "preauthorization" or "prior authorization" (they mean the same thing). That means your health plan has to review the doctor's plan for you before covering it.
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