Prior Authorization Approval
To ensure that the medical service ordered is medically necessary, prior authorization approval may be required for services ordered by In-Network or Out-of-Network Providers.
What services require prior authorization and how to obtain it?
In-Network
What services require prior authorization and how to obtain it?
Kaiser Permanente
For care with Kaiser Permanente in Oregon and Washington, providers will obtain any necessary prior authorization on your behalf and will submit claim forms to us.
First Choice Health, First Health Network, and Cigna HealthcareSM PPO Network1
For care with First Choice Health, First Health Network, and Cigna Healthcare PPO Network some services require prior authorization to be considered for payment under your insurance plan, such as inpatient care (for example: hospital surgical procedures), and some outpatient procedures. First Choice Health, First Health Network, and Cigna Healthcare PPO Network providers will obtain any necessary prior authorization on your behalf and will submit claim forms to us.
Your First Choice Health and First Health Network Providers must call 1-855-281-1840 (TTY 711) and Cigna Healthcare PPO Network providers must call 1-888-831-0761 for prior authorization. Failure to get prior authorization may result in greater out-of-pocket cost to you.
To learn more, review the prior authorization section in your Evidence of Coverage for details.
1. The Cigna Healthcare PPO Network refers to the health care providers (doctors, hospitals, specialists) contracted as part of the Cigna Healthcare PPO for Shared Administration.
Cigna Healthcare is an independent company and not affiliated with Kaiser Foundation Health Plan, Inc., and its subsidiary health plans. Access to the Cigna Healthcare PPO Network is available through Cigna Healthcare’s contractual relationship with the Kaiser Permanente health plans. The Cigna Healthcare PPO Network is provided exclusively by or through operating subsidiaries of The Cigna Group, including Cigna Health and Life Insurance Company. The Cigna Healthcare name, logo, and other marks are owned by Cigna Healthcare Intellectual Property, Inc.
Out-of-Network
Any other licensed provider or physician
What services require prior authorization and how to obtain it?
Some services require prior authorization to be considered for payment under your insurance plan, such as inpatient care (for example: hospital surgical procedures), and some outpatient procedures.
You are responsible for assuring your out-of-network provider has obtained necessary prior authorization. If an out-of-network provider recommends Services that require prior authorization, you need to ask them to request prior authorization by calling us at 855-281-1840 (TTY 711). If you don’t get prior authorization for services from out-of-network providers, you may have to pay the entire expense.
To learn more, review the prior authorization section in your Evidence of Coverage for details.