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Medical Necessity Reviews

Letter Mailed to Boeing Members in January 2020

Preservice Reviews – Avoid Coverage Issues and Unexpected Bills

For some services, Blue Cross and Blue Shield of Illinois (BCBSIL) may need additional information from your provider to determine coverage of a service under the plan. Preservice reviews, sometimes called prior authorizations, should be requested before you receive certain types of medical services or procedures. It's best to have your provider submit the information in advance to avoid having a claim delayed or denied later.

In-network providers usually handle the preservice review process for you, but it's always a good idea to check with your doctor to find out if a preservice review was completed.

You can check online to find out if your service has been submitted for preservice review:

  • Log in to Blue Access for MembersSM.
  • Go to "My Coverage", then "Referral" and "Prior Authorization Information".
  • In the BCBSIL App, go to "Referral" and "Prior Authorization".

Preservice Reviews – List of Outpatient Services

The below services typically call for additional medical information from your provider to determine coverage, also known as a preservice review.

The list below is current as of March 1, 2020, but it can change from time to time.

  • Advanced imaging (MRIs, CT scans and PET scans)
  • Applied Behavior Analysis (ABA) therapy
  • Cardiac imaging and stress testing
  • Clinical trials
  • Genetic testing, including lab tests for BRCA1 and BRCA2
  • Hospice (outpatient)
  • Joint and spine surgery, such as shoulder, knee, hip, and back surgeries
  • Obesity procedures (outpatient)
  • Pain management services, such as steroid injections, spinal cord stimulator or lysis of adhesions
  • Radiation therapy, including proton beam therapy
  • Select outpatient surgeries, such as breast lift or reduction
  • Some ear, nose or throat (ENT) services, such as bone conduction hearing aids, cochlear implants or surgery
  • Service for sleep disorders (includes sleep studies and CPAP)
  • Specialty drugs, such as infusion medications
  • TMJ / MPDS treatment (outpatient)
  • Transplantations (outpatient)

Preadmission Review – Inpatient Services

Preadmission review is required for all inpatient services, except childbirth or emergency admissions.

Details about your plan's inpatient preadmission review requirements can be found in the latest version of our Summary Plan Description (SPD). To access your SPD:

  • Go to Worklife
  • Go to "My Health & Well Being Benefits" in the Quick access box to access Your Benefits Resources
  • Select "Health & Insurance"
  • Then select "General Benefits Information" under "Learn About"
  • Or login directly to Your Benefits Resource
  • Select "Health and Insurance"
  • Then select "General Benefits Information" under "Learn About"

Call Boeing Member Services at 888-802-8776 for any questions. Boeing Member Services is available Monday through Friday, 5 a.m. to 5 p.m. PT (8 a.m. to 8 p.m. ET and 7 a.m. to 7 p.m. CT).