Some care needs approval first.
Preauthorization (or precertification) simply means that your plan administrator must approve certain kinds of care before you receive it, or the plan won’t cover the cost. There may also be preauthorization requirements, which specify the conditions, medical setting, or other limits to the plan's coverage. It’s typically required before inpatient admissions or certain ambulatory procedures.
In some cases, you’ll need preauthorization for the plan to pay for care. How you do this depends on your medical plan administrator. You’ll find yours on the back of your plan ID card.
- If Aetna, BlueAdvantage Administrators of Arkansas, or UnitedHealthcare is your administrator, preauthorization is required for certain services. Network providers will handle preauthorization directly for any medical services that require it. To help avoid unexpected medical costs, it's also a good idea to seek preauthorization for any out-of-network care. For the most current list of medical services requiring preauthorization, contact your medical plan administrator.
- If HealthSCOPE Benefits is your administrator, preauthorization is also required for certain services. Network providers will work with you to get any required preauthorizations for medical services, or you can call HealthSCOPE Benefits for assistance.