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Approval is needed from your health plan for certain health tests, services or treatments. It’s important to get approval before the service to make sure your care is safe, medically necessary and covered by the plan. If you visit in-network providers, they usually submit the prior authorization request for you. It’s always a good idea to check that your service was approved before it takes place to avoid surprise costs.
A Health Advocate can help you understand if your service needs prior authorization so call before you get care. You also can check the status online:
*Message and data rates may apply.
A clinical review of benefits is a review by medical staff to determine if the service you are requesting is appropriate for your medical needs. Clinical reviews are done prior to services so that you will know in advance if the procedure is covered.* The clinical review of benefits is dependent upon information submitted before the services are rendered. Payment is dependent upon the information submitted after the services are rendered.
A Health Advocate can assist if you need more information.
* Clinical review requests should be completed in 30 days or less, assuming all necessary information has been received. However, the review may take longer if additional information is requested. International Information: If translation is needed, time frame is 2-3 weeks. Quotations of benefits and/or the availability or extent of coverage are not a guarantee of payment. Payment is subject to actual information and charges submitted.