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What is PA?
What is PA?
Your health care services and supplies need approval from your health plan first. This just means your providers need to get permission before they provide your services and supplies. They’ll know how to do this. And we’ll work with them to make sure the service is what you need.
How PA works
How PA works
Here’s how the PA process works:
- Your provider will give us info about the services they think you need.
- We’ll review the info.
- You and your provider will get a letter when we approve or deny a service.
- If we can’t approve the request, a different health plan provider will review the info.
- If we deny your request, we’ll explain our reasons in the letter.
- If we deny a request, you or your provider can file an appeal.
Right care, right place, right time
Right care, right place, right time
PA is a type of utilization management (UM). It allows us to be sure you’re getting the right care at the right place and time, before you get it.
UM is the process we use to make sure you get covered quality services that are medically necessary. And we use state and national guidelines to be sure we’re doing the right thing. We make decisions about health care based on:
- The most appropriate care
- Services available
- Benefit coverage
You may have concerns about our practices. We want to assure you that we don’t:
- Reward any providers or staff for denying coverage or services
- Give money to providers or staff to make decisions that keep you from getting the right care
- Hire, promote or end contracts with providers based on the likelihood they’ll deny your benefits
Our goal is to help you be as healthy as you can be. So we want you to have the right care. You and your provider can talk about all treatment options, whether we cover them or not.
Questions? Just call us at 1-855-456-9126 (TTY: 711). We’re here for you, 24 hours a day, 7 days a week.