15 Aug Want to Be a Savvy Consumer When It Comes to Prior Authorization?

Follow these steps:

1. First and foremost, please do not hesitate to call us to discuss the details of your coverage if you have a test or procedure coming up, or if you are prescribed a new medication. We’re here to help.
2. If you are taking a medication or have received a new prescription, please check our formulary. If you see a PA in the notes column next to the name of your medication, have a conversation with your doctor about alternatives that may be safer and less expensive for you. We’ve tried to make our formulary easy to read, but you can always call us if you have questions.
3. On the medical side, we have an easy to use, one-page document that describes frequently requested services that are subject to prior authorization. While it’s not a complete and detailed list, it’s in a format that is easy to bring to your doctor’s appointment. We offer more detailed information online that you or your doctor can review.
4. If you have a test or procedure coming up that requires prior authorization, please make sure your doctor has submitted the request. Once the form is submitted, you can use one of the numbers below to check on the status.
   • For medical or behavioral health services, call Member Services at 1.877.514.2442.
   • For drugs and other pharmacy services, call OptumRx 855.577.6545.
5. Similarly, sleep studies and certain medical devices and their replacements are also subject to approval. If you are directed by your doctor to get a sleep study or use medical equipment, please ensure that the appropriate authorizations are submitted. Please call us to understand the replacement schedule.
6. If your authorization is approved, please read the letter carefully to understand which services are authorized. If more care is needed beyond the original authorization, your doctor will need to submit another request.
7. If your authorization is denied, you will receive a written notice. Please take the time to understand the reason why the denial occurred. It is not uncommon for our members to find out that they have less invasive, safer alternatives available to them after receiving their notice, and many of our members are grateful for this. It is our goal to empower you to make informed decisions with your doctor.

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