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Learn about the medical, dental, pharmacy, behavioral, and voluntary benefits your employer may offer. Learn more about prior authorization, the process to get pre-approval, and the impact of the No Surprises Act. Under medical and prescription drug plans, some treatments and medications may need approval from your health insurance carrier before you receive care.
Prior authorization is usually required if you need a complex treatment or prescription. Coverage will not happen without it. Ask your health care provider if a prescription or medical treatment is going to require prior authorization so they can start the process immediately. This is not the same as if you need additional treatments or prescriptions after your initial visit. Prior authorization may be needed before getting outpatient services in a hospital or hospital-affiliated facility.
The No Surprises Act was enacted in and goes into effect on January 1, Surprise bills arise in emergencies when patients typically have little or no say in where they receive care. They also arise in non-emergencies when patients at in-network hospitals or facilities receive care from providers such as anesthesiologists who are not in-network and whom the patient did not choose.
The law requires surprise bills must be covered without prior authorization and in-network cost sharing must apply. Review your plan documents or call the number on your health plan ID card for more information about the treatments, services, and supplies that require prior authorization under your specific plan.
Typically, within business days of receiving the prior authorization request, your insurance company will either:. These responses are based on input from clinical pharmacists and medical doctors who review the requests at the health insurance company.
No, prior authorization is not required if you have an emergency and need medication. However, coverage for emergency medical costs are subject to the terms of your health plan. The prior authorization process gives your health insurance company a chance to review how necessary a medical treatment or medication may be in treating your condition.
For example, some brand-name medications are very costly. During their review, your health insurance company may decide a generic or another lower-cost alternative may work just as well in treating your medical condition. Review your plan documents or call the number on your plan ID card for more information about the treatments, services, and supplies that require prior authorization under your specific plan. All rights reserved. For availability, costs and complete details of coverage, contact a licensed agent or Cigna sales representative.
This website is not intended for residents of New Mexico. Selecting these links will take you away from Cigna. Cigna may not control the content or links of non-Cigna websites. Prior Authorization How to request precertifications and prior authorizations for patients.
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AUTHORIZATION REQUIREMENTS For dates of service on or after January 1, This document lists services, items and medications that require authorization prior to being . Manage your Cigna Prior Authorization Requests Our electronic prior authorization (ePA) solution provides a safety net to ensure the right information needed for a determination gets . prior authorization form Fax #: - Please a llow hours for acknowledgement of pending review. Complete this form in its entirety and attach clinical to support medical .