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 (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.