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 and First Health Network
For care with First Choice Health and First Health 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 and First Health Network providers will obtain any necessary prior authorization on your behalf and will submit claim forms to us.
To learn more, review the prior authorization section in your Evidence of Coverage for details.
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.
Need prior authorization?
Call 1-855-281-1840 (TTY 711).