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 treatment/management
- Cochlear implant evaluations and services
- Durable medical equipment
- Genetic counseling and testing
- Growth hormone and other prescription drugs with special prescribing or monitoring indications
- Hearing aids (for children under age 18)
- Home health care
- Hospice care
- Physical, speech, and occupational therapy services
- Psychological and neuropsychological testing
- Reconstructive or plastic surgery
- Second opinion consultations
- Skilled nursing facility care
- Skilled rehabilitation services
- Specialty drugs and high-cost drugs with unique monitoring or delivery needs*
- Specialty radiology (e.g., Magnetic Resonance Imaging (MRI), Computed Tomography (CT), and Positron Emission Tomography (PET) scans) provided on an outpatient basis.*
Note: Preauthorization of these services is not required in connection with emergency care.
- Transplant evaluations, services, and procedures
- Treatment of temporomandibular disorders (TMD)
* Preauthorization required as of July 1, 2010 |
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