What is pre-authorization and when is it required?
A pre-authorization is a request made prior to a procedure to verify benefits and medical appropriateness of the procedure. This allows the patient to make an informed decision of potential coverage for the procedure in advance. If you are unsure about whether a service or procedure should be pre-authorized, contact a customer service representative for more information. Please note: A summary of benefits and/or eligibility is not a guarantee of payment. Benefit determinations will be based on eligibility and plan limits at the time services are rendered. Benefits information only applies to procedures and diagnoses that are covered by the plan. We encourage you to review the SPD, Summary Plan Description, to determine if the charges in question are covered expenses. Pre-authorization requests for a specific diagnosis or procedure must be submitted in writing.
