Authorization requests

Authorization requests aren't required for members using their alternate benefits or out-of-network benefits. Some employers and Medicare plans offer benefits that provide a member an out-of-network benefit with higher copays. If you refer to a provider that doesn't participate with us or the member chooses to go to a non-participating provider, this will be paid at his/her alternate or out-of-network benefit.

To save you some administrative burden, we ask that you not fax authorizations to our medical department in these instances. The only times we need a formal request are for high-tech imaging, inpatient stays and the outpatient procedures that normally require authorizations.

PriorityMedicare Choice^SM, a PPO product, doesn't require prior authorization for out-of-network benefits.

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