Make Sure You’re Covered

  • Avoid surprise medical bills

    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:

    • 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 go
    • Avoid unnecessary services
    • Avoid inappropriate or unnecessary medical treatment

    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.

    Doctors who are in the Premera network can request preapproval for you

    Healthcare providers who are in the Premera network are familiar with the process for getting preapproval. 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. Always ask your healthcare provider about requesting preapproval before you schedule a service or procedure.

    What if your doctor doesn't request preapproval?

    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, read or download your benefit booklet.

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

    Some services that require preapproval*

    • Planned admission into hospitals or skilled nursing facilities
    • Some inpatient surgeries
    • Nonemergency ground or air ambulance transport
    • Advanced imaging, such as MRIs, CT scans, and cardiac imaging
    • Transplant and donor services
    • Some planned outpatient procedures and surgeries
    • 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
    • Some drug treatments

    *The above is not a complete list and shows only some of the services and drug treatments that require preapproval or prior authorization. Your doctor has the current list and medical information needed to request a preapproval or prior authorization on your behalf.

    Note: 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

    • Hospital admission for childbirth and newborn care
    • Emergency admission to hospital
    • Office visits to a primary care doctor, family doctor, or specialist

    Questions?

    Contact us