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You may need to preauthorize certain covered health services to ensure you avoid unexpected costs. Preauthorization means that you need to get approval from your health insurance before you can have certain health services performed. This is important to know before you get these services, so we can help you avoid higher costs.
Usually, your network provider will take care of this before the service is performed. But it’s best to confirm for yourself. Call 1-800-572-3089 before you get care.
A predetermination of benefits is a review by medical staff to determine if the service you are requesting is appropriate for your medical needs. Predeterminations are done prior to services so that you will know in advance if the procedure is covered.* The predetermination of benefits is dependent upon information submitted before the services are rendered. Payment is dependent upon the information submitted after the services are rendered.
Blue Cross and Blue Shield of Illinois Customer Service is able to assist you with initiating a predetermination of benefits. Please contact Customer Service at 1-800-572-3089 for additional information.
We highly encourage you to request a predetermination for the following list of services. Please note that this is not an all-inclusive list.
|Pet Scan||MRI of the Breast|
In order to begin the review process, your health care provider will need to forward all information requested:
Physicians can download a Predetermination Request Form , and return form with applicable information to:
Blue Cross and Blue Shield of Illinois
P.O. Box 805107
Chicago, IL 60690-1364
Predetermination* 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.