Services Requiring Preauthorization
All inpatient admissions, selected surgical procedures and certain outpatient procedures require approval before they are performed. When care is performed or coordinated by your Primary Care Physician (for those in the HMO and POS Plans), the network provider is responsible for obtaining preauthorization for you.
If you self-refer for care, or use an out-of-network provider, it is your responsibility to obtain preauthorization for those services requiring it. To obtain preauthorization, call 1.800.471.2242 or ask your provider to call. (Note: For HMO members, preauthorization must be obtained by the provider. Members may not self-refer for care requiring preauthorization.)
View the PDFs* below to review the services that require preauthorization for your coverage type:
2013 Preauthorization Requirements
- Capital BlueCross Products Traditional, Comprehensive, PPO
- Capital BlueCross POS
- Keystone Health Plan Central HMO
Note: Investigational/experimental and cosmetic procedures are not eligible for coverage under most Plans. To determine if a service is investigational/experimental or cosmetic, please contact the Preauthorization Department.
To obtain preauthorization, contact the Clinical Management Department by calling 1.800.471.2242, Monday through Friday, 8 a.m.-6 p.m. EST.