Did you know that many services and procedures require an OK for coverage from Premera before you get them? This is called preapproval, 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 preapproval and they can contact Premera on your behalf. (The term they might use is prior authorization.) In-network doctors have all of the medical information needed to ask that your medical service be reviewed and approved for coverage. Always ask your healthcare provider about requesting preapproval before you schedule a service or procedure.
If your doctor provides a service that requires preapproval 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 preapproval requirements, sign in and access your benefit booklet.
To avoid extra costs, always ask your healthcare provider to request preapproval before you have a planned medical service.
All plans: preapproval list for 2020
Individual/Family plans: preappoval list for 2020
If you have a prescription plan benefit, some drugs must be approved for coverage through our Pharmacy preapproval program. Learn more about drugs requiring approval.
Services that do not require preapproval
No one likes surprise bills, especially when you've tried to make sure all of your care is in network. The Washington Balance Billing Act aims to fix this.
You might be contacted by AIM Specialty Health or eviCore. Read more about these companies and how they work with us.
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