Explore prior authorization

Ahead of some services, we ask your doctor to contact our medical team to discuss and agree on your course of treatment. This pre-approval process (also known as prior authorization) helps ensure you get the right care at the right time and place.

We know the prior authorization process can feel stressful. We work to make this process as simple and efficient as we can to help ensure your medical services or supplies will be covered.

Ready to learn more? Find out which services or supplies (excluding drugs) need pre-approval and see our prior authorization performance metrics to learn how long our standard and expedited approval requests take to process.

Medicare Advantage (MA) Plans

Find services and supplies that need pre-approval (prior authorization) for a Medicare Advantage plan.

View the MA list

Marketplace Plans

Find services and supplies that need pre-approval (prior authorization) for individual and family qualified health plans (QHPs) bought through the Marketplace. Plan types (HMO/HMO-POS or PPO/EPO) are found on member ID cards.

View the HMO/HMO-POS list

View the PPO/EPO
list

Transparency you can trust

We’re committed to providing our members with access to high-quality health care when they need it. Plus, sharing our prior authorization metrics complies with the Centers for Medicare & Medicaid Services (CMS) Interoperability and Prior Authorization Final Rule (CMS-0057-F).

Our pre-approval information shows our dedication to making thoughtful, swift decisions about your medical care so you can take the next step in your health care journey.

Review our approval rates by plan type (in either chart or table form) to see: pre-approvals, appeals, and decision time needed. Please note these numbers will be updated annually and approval of services or medical supplies doesn’t guarantee payment for them. Coverage is based on your plan’s benefits.

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Standard pre-approval requests

The following numbers show the percentage of prior authorization requests we approve, the number of days the process takes, and the percentage of appealed requests we approve. Your experience and timing may vary based on many factors, but we'll always work to get you an answer quickly so you can plan your next health care step.

Requests approved

91% approved

9% denied

Days to Decision

2.1 days* on average

* Guidelines allow up to 14 days.

Appealed Requests

55% approved

45% denied

Expedited pre-approval requests

For time-sensitive requests from your doctor, the following numbers show the percentage of prior authorization requests we approve, the percentage of appealed requests we approve, and the average number of hours the expedited process takes.

Requests approved

92% approved

8% denied

Hours to Decision

14.4 hours* on average

* Guidelines allow up to 72 hours.