Make Sure You're Covered

  • Don't be surprised by a bill you weren't expecting

    About pre-approval

    Did you know that some services and procedures need to get an OK for coverage from Premera before you get them? This review is called a pre-approval, and it helps you:

    • Find out if you're covered by your benefits before you have your scheduled procedure
    • Save money and avoid extra costs
    • Get an estimate of your out-of-pocket costs before you get your service
    • Avoid unnecessary services

    Your doctor should request a pre-approval for you

    Your healthcare provider is familiar with the process for getting a pre-approval. So, it's best if your doctor contacts Premera on your behalf. Your doctor has all of the medical information needed to ask that your medical service be reviewed and approved for coverage.

    What happens if your doctor doesn't request a pre-approval

    If your doctor gives you a service that requires a pre-approval without requesting one, that service may not be covered. Refer to your benefit booklet to see your medical benefits and pre-approval requirements.

    To avoid extra costs always ask your healthcare provider to request a pre-approval before you have a planned medical service.

    Some services that require a pre-approval*

    • Planned admission into hospitals or skilled nursing facilities
    • Non-emergency ground or air ambulance transport
    • Advanced imaging, such as MRIs and CT scans
    • Transplant and donor services
    • Some planned outpatient procedures
    • Some injectable medications you get in a healthcare provider's office
    • Prosthetics and orthotics other than foot orthotics or orthopedic shoes
    • Reconstructive surgery
    • Home medical equipment costing $500 or more

    Your doctor has the most current list and medical information needed to request a pre-approval on your behalf.

    Some prescription drugs require a pre-approval review to approve coverage. Learn more about drugs requiring approval.

    Services that do not require a pre-approval

    • Hospital admission for childbirth and newborn care
    • Emergency admission to hospital


    Call customer service at 877-995-2696