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Prior authorization
There are some types of care that need to be preapproved by your doctor. We’ll connect you to the right care when you need it. Just follow the directions below to find out more about getting prior authorization for care.
What is prior authorization?
What is prior authorization?
Some care will require your doctor to get our approval first. This process is called prior authorization or preapproval. It means that Aetna Better Health® of California agrees that the care is necessary for your health. You never need preapproval for emergencies. Even when you are outside of your network.
These are some of the common services that need prior authorization or preapproval:
- Overnight hospital stays
- Services outside of the Aetna Better Health service area
- Major surgeries
- Specialist visits
- Expensive medications administered by your provider or at your provider’s office
- Any service that is considered medically necessary
How to get prior authorization
How to get prior authorization
Follow these steps to get preapproval:
- Click here for prescription drugs
- Your primary care physician (PCP) will give Aetna Better Health of California information about the services that they think you need.
- An Aetna Better Health of California provider will review the information.
- If that provider doesn’t think the request should be approved, a different Aetna Better Health of California provider will review the information.
- You and your provider will get a letter stating whether the service has been approved or denied.
- We will make a decision within 5 business days, or 72 hours for urgent care.
- If we deny your service, we will explain why in the letter.
- If we deny a service, you or your provider, with your written permission, can file an appeal.
Grievances and appeals
If you would like to file a complaint or make an appeal, you can visit our grievances and appeals page to learn more.