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Coverage Information

Call your PCP when you need regular care. He or she will send you to see a specialist for tests, specialty care and other covered services that he or she doesn’t provide. Be sure your PCP approves you to see a specialist. We will cover this care. If your PCP does not provide an approved service, ask him or her how you can get it.

Prior Authorization

Prior authorization (or PA for short) means we must approve a service or prescription drug before you can get it. You or your PCP/specialist should contact us to ask for this approval. If we do not approve your request, we’ll let you know. Plus, we’ll give you details about how to file an administrative review. See your member handbook for more on administrative reviews.

How to Get an Authorization

Getting Authorization

Type of Request Decision Time Frame Who Can Request One How to Request
Normal* 
(for non-
emergency care)
14 business days You or your provider Call: 1-866-231-1821
Fax: 1-813-262-2907
Expedited/Fast 
(for urgent care,
when you think
your health could
be in danger) 
One business day
(24 hours)*
You or your provider  Call: 231-1821 
Fax: 262-2907
Say: ‘I’d like an
expedited/fast decision”

*Sometimes we may need more time to make a fast decision. If so, we’ll make it within three business days.

Please note: PA decisions for services that have already been provided are made within 30 days of us getting all needed information.

Services Available Without Authorization

You do not need approval from us or your PCP for the following services:

  • Direct access to in-network women's health specialists for routine and preventive health care services
  • Emergency/urgent care
  • Family planning (any health plan provider)
  • One women’s health visit to an OB/GYN provider each year
  • Post-stabilization care
  • Visits to your PCP

Even though you do not need approval for these services, you will need to pick a network provider. 

You can find a provider using our online Find A Provider tool.

When you’ve made your choice, call to set up an appointment. Remember to take your ID card with you.

  • Getting Authorization

    Getting Authorization

    Type of Request Decision Time Frame Who Can Request One How to Request
    Normal* 
    (for non-
    emergency care)
    14 business days You or your provider Call: 1-866-231-1821
    Fax: 1-813-262-2907
    Expedited/Fast 
    (for urgent care,
    when you think
    your health could
    be in danger) 
    One business day
    (24 hours)*
    You or your provider  Call: 231-1821 
    Fax: 262-2907
    Say: ‘I’d like an
    expedited/fast decision”

    *Sometimes we may need more time to make a fast decision. If so, we’ll make it within three business days.

    Please note: PA decisions for services that have already been provided are made within 30 days of us getting all needed information.

  • Services Available Without Prior Authorization

    Services Available Without Authorization

    You do not need approval from us or your PCP for the following services:

    • Direct access to in-network women's health specialists for routine and preventive health care services
    • Emergency/urgent care
    • Family planning (any health plan provider)
    • One women’s health visit to an OB/GYN provider each year
    • Post-stabilization care
    • Visits to your PCP

    Even though you do not need approval for these services, you will need to pick a network provider. 

    You can find a provider using our online Find A Provider tool.

    When you’ve made your choice, call to set up an appointment. Remember to take your ID card with you.

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Last Updated On: 3/16/2017