Did you know that many services and procedures require an OK for coverage from Premera before you get them? This is called prior authorization, and it helps you:
Premera uses a team of experienced doctors, nurses, and healthcare analysts to determine if a medical procedure is appropriate and supported by clinical best practices.
Healthcare providers who are in the Premera network are familiar with the process for getting prior authorization. They can contact Premera on your behalf. In-network doctors have all of the medical information needed to ask that your medical service be reviewed and approved for coverage. You should always ask your healthcare provider about requesting prior authorization before you schedule a service or procedure.
For PersonalCare Plans, you must choose a primary care provider who's a member of your partner system. You'll need to obtain a referral from your provider if you need specialty care, and non-emergency services outside your partner system are covered only when you're referred by your primary care provider.
If your doctor gives you a service that requires prior authorization without requesting one, you may have to pay part or all of the cost, above your usual cost shares.
For complete information about your plan's medical benefits and prior authorization requirements, read or download your benefit booklet.
To avoid extra costs always ask your healthcare provider to request prior authorization before you have a planned medical service.
The list below shows some services and procedures that require prior authorization.
Please note: If you have a prescription plan benefit, some drugs must be approved for coverage through our Pharmacy Prior Authorization Program. Learn more about drugs requiring approval.
* This is not a complete list and shows only some of the services and drug treatments that require prior authorization. Your doctor has the most current list and medical information needed to request prior authorization on your behalf.
Call Customer Service at the number on your Premera member card.
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