February 2, 2023

Here’s a Term You Need to Know

What is Pre-Authorization? Pre-authorization means getting approval for certain services or supplies before they are provided. This process ensures you are getting safe, effective, and appropriate treatment.

The Health Plan requires pre-authorization for specific care, such as:

• Some surgeries and reconstructive surgery

• Planned admission into hospitals or skilled nursing facilities

• Specialized imaging such as MRIs, CT scans, and cardiac imaging

• Non-emergency air ambulance transport

• Home medical equipment

• Interventional pain procedures

• Physical medicine services such as physical therapy and chiropractic care

• Sleep studies

• Some high-cost injectable medications and specialty drugs

When pre-authorization is required, you must receive approval before you receive the service or supply. If you don’t, your Health Plan will not cover those costs and the doctor may bill you for the full cost.

An in-network provider will obtain pre-authorization for you when it is required. If you use an out-of-network doctor, you may need to request preauthorization yourself.

Get all the details at regence.com; sign in, click My Plan, then Check benefits & coverage.

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