Prior Authorization

Health insurance companies design prior authorization processes to evaluate the medical necessity of certain services. Blue Cross’ authorization process ensures that members receive the highest level of benefits in the most appropriate setting and level of care for a given medical condition.

Self-funded group employers may choose to require prior authorization on services other than those listed. Self-funded group members should ask their employer for a list of services that require prior authorization for that group.


Authorization Types

Medical

Blue Cross may require approval for specific items and services. Click the button below to view our Product Enhancement Guide and review Pages 9-12 for lists of services that require prior authorization. These apply to fully insured, commercial plans. To see if you are a fully insured member, check your ID card for the words “Fully Insured” in the top right corner.

2024 Product Enhancements Guide

Prescription Drugs

Your doctor must get prior authorization before your health plan may cover certain prescription drugs. Please click the link below to see a list of drugs that require prior authorization. We update this list as new drugs require prior authorization.
Benefits may vary by group and individual plans. Your plan may not cover all the drugs on this list.
Drugs Requiring Prior Authorization

Dental

Limited Benefit Dental Plans and Orthodontics Coverage Medically necessary orthodontics services covered by limited benefit dental plans require prior authorization. If you have this type of dental coverage, your plan information will have one of these numbers on the first page: 97176EX-039 or 97176EX-040. Please read your benefit information for coverage details or call United Concordia Dental at the toll-free number on your health insurance or dental ID card.

Health Plans and Dental/Oral Surgery Coverage
Dental or oral surgery services covered by health insurance plans may require prior authorization. Please read your health plan benefit information for coverage details or call Customer Service at the toll-free number on your health insurance ID card.

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