Did you know that many services and procedures require an OK for coverage from Premera before you get them? This is called pre-approval, 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 pre-approval. 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 pre-approval before you schedule a service or procedure.
If your doctor provides a service that requires pre-approval 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 pre-approval requirements, read or download your benefit booklet.
To avoid extra costs, always ask your healthcare provider to request pre-approval before you have a planned medical service.
*The above is not a complete list and shows only some of the services and drug treatments that require pre-approval or prior authorization. Your doctor has the current list and medical information needed to request a pre-approval or prior authorization on your behalf.
Please note: If you have a prescription plan benefit, some drugs must be approved for coverage through our Pharmacy pre-approval program. Learn more about drugs requiring approval.
Services that do not require pre-approval
Call the customer service number on your Premera member card.
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