• Make sure you're covered

    Don’t be surprised by a bill you weren’t expecting

    About Prior Authorization

    Did you know that you may be required to get an approval for coverage from your health plan before you have a planned medical service or procedure? This is called a prior authorization, 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 prior authorization for you

    Your healthcare provider is familiar with the process for getting a prior authorization. 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 prior authorization

    If your doctor gives you a service that requires a prior authorization without requesting one, you may have to pay extra costs. Refer to your benefit booklet to see your medical benefits and prior authorization requirements.

    To avoid extra costs always ask your healthcare provider to request a prior authorization before you have a planned medical service. 

    The list below shows some services and procedures that require a prior authorization. 

    Some services that require a prior authorization*

    • 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 prior authorization on your behalf.

    Some prescription drugs require a prior authorization review to approve coverage. Learn more about drugs requiring approval.

    Services that do not require a prior authorization

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

    Questions?

    Call Premera Partner Services at 877-728-9020