Preauthorization
Getting preapproval for some services.
Preauthorization (also called precertification) means you need approval for certain services before you get care or the plan won’t cover the cost. It’s most often required for hospital inpatient admissions and outpatient surgery. Your plan may also set certain conditions, medical settings, or other limits to coverage.
How does it work?
If you need preauthorization from a network doctor or hospital, your doctor will usually handle it for you; however, you should double-check by calling your plan (the numbers are shown below).
Here are some common services that usually need preauthorization:
- Inpatient admissions for hospital or behavioral health facilities
- Outpatient surgery, radiology, or dialysis
- Outpatient mental health and substance abuse services
- Home health care
- Rehabilitation services (physical, occupational, or speech therapy)
- Services provided under the Centers of Excellence program.
When should you call?
If your doctor doesn’t help with preauthorization, or if you’re considering care outside your plan’s network, you’ll need to call for preauthorization yourself.
You’ll find the number for your administrator on the back of your plan ID card. Not sure who your administrator is? Visit the Plan Availability Tool to find out.
- Aetna (includes Banner Local Plan): 855-548-2387
- BlueAdvantage of Arkansas: 866-823-3790
- HealthSCOPE Benefits (includes Mercy Arkansas, Ochsner, and UnityPoint Local Plans): 800-804-1272
- UMR: 855-870-9177
See the 2022 Associate Benefits Book for more information about your benefits and eligibility. This document will control in the event of any conflict.
Need help?
Call People Services at Contacts
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